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BIDDLE'S 



MATERIA MEDICA 



AND 



THERAPEUTICS 



MATERIA MEDICA 



AND 



THERAPEUTICS, 



FOR PHYSICIANS AND STUDENTS. 



,'"' BY 



JOHN B. BIDDLE, M. D., 

LATE PROFESSOR OF MATERIA MEDICA AND GENERAL THERAPEUTICS IN THE JEFFERSON MEDICAL 
COLLEGE, PHILADELPHIA. 



TWELFTH EDITION, 

REVISED, REARRANGED AND ENLARGED, 

WITH SPECIAL REFERENCE TO THERAPEUTICS, TOXICOLOGY, AND 
TO THE PHYSIOLOGICAL ACTION OF MEDICINES. 



«. BY 

CLEMENT BIDDLE, M. D., 

MEDICAL CORPS U. S. NAVY. 



WITH 

NUMEROUS ILLUSTRATIONS, MANY OF WHICH ARE 



NEW TO THIS EDITION. 



OCT 26 U 

PHILADELPHIA: 

P. BLAKISTON, SON & CO.,^'^ 



No. 1012 Walnut Street, 
1892. 




Entered, according to Act of Congress, in the year 1892, 

By P. BLAKISTON, SON & CO., 
In the Office of the Librarian of Congress, at Washington. 



Press of 

The Jas. B. Rodgers Printing Co., 

Philadelphia. 



PREFACE 

TO THE TWELFTH EDITION 



In preparing this edition of the Materia Medica and Therapeutics 
the editor here desires to call attention to the many changes made 
in the work, which has received at his hands a careful and thorough 
revision, bringing it up, he believes, fully to date, and which he 
trusts will now be found to be a reliable text book upon the subjects 
of which it treats. 

For the sake of reference and system the chapters on the con- 
sideration of each remedy, where practicable, have been arranged 
under the headings, Description, Chemical Constituents, Incom- 
patible, Aids, Contraindications, Physiological Effects, Tox- 
icc x>gy, Antidotes, Medicinal Uses, and Administration. This 
division, it is thought, will materially aid the student in his studies. 

In detail the following additions and alterations have been made, 
viz.: New articles beginning at page 54, upon the classification ot 
Pharmacological Agents; then on Sulphonal; the Myotic Alka- 
loids; the Alum, Sulphur, Saline, Lithian, Calcareous, and Alkaline 
Natural Waters; Enemata; Exalgine; Aristol; Ichthyol; and lastly 
Dermatol. The consideration of Electrical Therapeutics and the 
chapters on Cocaine, Naphthaline, and Naphthol, will be found 
much amplified and largely rewritten. Iodoform and Iodol are 
transferred from Alteratives to Antiseptics as being more in con- 
formity with their physiological effects. 



vi PREFACE TO THE TWELFTH EDITION. 

Nineteen new cuts have been added to this edition as well as a 
complete index of Diseases and Remedies. Exclusive of the 
two indexes, the work has been increased by thirty-three pages ; 
while the Index itself, which seemed altogether too full, has been 
materially cut down. 

The editor here desires to thank most cordially Dr. T. D. Reed, 
of the Montreal College of Pharmacy, for various suggestions and 
corrections furnished by him for this edition. His thanks are also 
due to Prof. F. B. Power, who kindly pointed out some errata in 
the eleventh edition, and to Dr. Henry Morris, who contributed 
much material, particularly the chapter on Antiseptics and Anti- 
pyretics, to the same edition. 

Anyone discovering errors in this work, and who will take the 
trouble, for the sake of future accuracy, to report the same to the 
Publishers or Editor, will be sincerely thanked for their pains. 

The Editor takes great pleasure, as in former editions, in renewing 
his dedication of this work to the gentlemen in attendance upon the 
various medical schools of North America. 

Clement Biddle. 

1902 Pine St., Philadelphia, October, 1892. 



PREFACE 



TO THE EIGHTH EDITION 



The exhaustion of the seventh edition of the Materia Medica 
within little more than a year since it was issued, having rendered 
necessary the publication of a new edition, it has been carefully 
revised, much of it has been recast and even rewritten, and many 
new articles have been added. The author trusts that it will be 
found to have kept pace with the progress of pharmacological 
science, and to contain all important recent contributions to the 
various departments of pharmacology. 

The illustrations of the book comprise, as in previous editions, 
representations of most of the important indigenous and natu- 
ralized plants, as well as diagrams of instruments employed in the 
atomization of liquids, in the new operation of pneumatic aspira- 
tion, in the transfusion of blood, and in the recently-introduced 
pneumatic method in the treatment of thoracic diseases. 

The author has aimed in this, as in previous editions, to present 
a succinct account of the articles of the Materia Medica in general 
use in the United States, and discussed in the courses of lectures 
delivered upon the subject, to which he trusts the work will be 
found, as heretofore, to furnish a suitable text-book. He takes 
pleasure in renewing his dedication of it to the gentlemen in 
attendance upon the various medical schools in North America. 

John B. Biddle. 



CONTENTS. 



PAGE 

Remedies — Definition of '.. 33 

Division of ' 33. 

» 

PART I. 

MECHANICAL REMEDIES. 

General Blood-letting. . „• 34 

Local Blood-letting ». 35 

Leeches and Cups 35 

Scarifications '. . 36 

Setons and Issues . 36 

Bandages, Frictions 36 

Acupuncture, Baunscheidtismus 37 

Pneumatic Aspiration 37 

PART II. 

IMPONDERABLE REMEDIES. 

Light 39 

Heat 40 

Cold 41 

Electricity 43 

Massage 51 

PART III. 

PHARMACOLOGICAL REMEDIES, OR MEDICINES. 

Medicines —Definition of 52 

Modus operandi of 56 

Circumstances which modify the Effects of 57 

Forms in which they are used 58 

Solids 58 

Liquids 60 

Semi-solids 64 

Gases and Vapors 65 

Weights and Measures 66 

Effects of Age, Sex, Temperament, Idiosyncrasy, Disease, Habit, etc., 

upon 68 

Parts to which medicines are applied 71 

To the Skin , . 71 

The Hypodermic method 71 

To Mucous Membranes 72 

ix 



x CONTENTS. 

PAGE 

Atomization 73 

To Serous Membranes 76 

To Ulcers, Wounds, Abscesses, etc 76 

Intra-venous injection 76 

Transfusion of Blood 76 

Classification of Medicines 77 

Class I. — Neurotics 78 

Order I . Narcotics 78 

Opium 79 

Lactucarium 90 

Paraldehyd 91 

Sulphonal 93 

Hypnone 94 

Urethan *. . . 95 

Belladonna 95 

Stramonium 101 

Hyoscyamus .. 102 

Buboisia 105 

Cannabis Americana 106 

Cannabis Indica 106 

Humulus (Hops) 109 

Dulcamara (Bittersweet) 110 

Order II. Ethereal Anaesthetics m 

.-Ether (Ether) 1 1 1 

Chloroformum (Chloroform) 115 

Methylene Bichloride 118 

Methylic Ether 119 

Nitrous Oxide Gas 119 

Ethyl Bromide 120 

Local Anaesthesia 120 

Order III. Antispasmodics 121 

Asafoetida (Asafetida) . . . 121 

Galbanum 123 

Ammoniacum, (Ammoniac) . . . • 123 

Camphora (Camphor) 123 

Valeriana (Valerian) 127 

Ammonii Valerianas (Ammonium Valerianate) 128 

Cypripedium 128 

Scutellaria 1 28 

Thea (Tea) 128 

Caffea (Coffee) 129 

Caffeina (Caffeine) 129 

Theobroma (Chocolate) 130 

Erythroxylon (Coca) 130 

Cocaine 131 

Guarana 136 

Mate 136 

Moschus (Musk) . 136 

Oleum Succini (Oil of Amber) 137 



CONTENTS. xi 

PAGE 

Oleum .Ethereum (Ethereal Oil) 138 

Spiritus .Etheris Compositus (Compound Spirit of Ether) 138 

Order IV. Tonics 139 

Vegetable Tonics 140 

Simple Bitters 14° 

Quassia 140 

Gentiana (Gentian) 141 

Calumba t 142 

Chirata 143 

Aromatic Bitters M3 

Serpentaria 143 

Eucalyptus 145 

Anthemis 146 

Eupatorium 146 

Absinthium * . 147 

Magnolia 148 

Cascarilla ; 148 

Astringent Bitters 149 

Cinchona 149 

Quininae Sulphas (Quinine Sulphate) ....; 157 

Quininae Bisulphas (Quinine Bisulphate) „ - 158 

Quininae Valerianas (Quinine Valerianate) 158 

Quininae Hydrobromas (Quinine Hydrobromate) l 5& 

Quininae Hydrochloras (Quinine Hydrochlorate) 159 

Chinoidinum (Chinoidin) 159 

Cinchoninae Sulphas (Cinchonine Sulphate) .... 159 

Quinidinae Sulphas (Quinidine Sulphate) 159 

Cinchonidinae Sulphas (Cinchonidine Sulphate) 159 

Cornus 160 

Salix 161 

Prunus Virginiana (Wild Cherry) 161 

Digestive Ferments . . > 162 

Pepsinum (Pepsin) 162 

Pancreatinum (Pancreatin) 163 

Papaya 163 

Mineral Tonics 164 

Ferri Praeparata ( Preparations of Iron) .~^C 164 

"""f Chalybeate Waters (North America) 174 

Chalybeate Waters (Europe) 175 

Mangani Praeparata (Preparations of Manganese) 175 

Acida Mineralia (Mineral Acids) 176 

Acidum Lacticum (Lactic Acid) 181 

Phosphorus 182 

Zinci Phosphidum (Zinc Phosphide) 185 

Order V. Astringents 185 

Vegetable Astringents 186 

Acidum Tannicum (Tannic Acid) 186 

Acidum Gallicum (Gallic Acid) 188 

Galla (Nutgall) 189 



i CONTENTS. 

PAGE 

Catechu 19° 

Kino 190 

Krameria 19 1 

Hematoxylon 192 

Quercus Alba (White Oak) 192 

Geranium 193 

Hamamelis 1 , 193 

Rosa Gallica (Red Rose) 195 

Rosa Centifolia (Pale Rose) 195 

Rhus Glabra (Sumach) 195 

Rubus (Blackberry) 195 

Castanea (Chestnut) 196 

Mineral Astringents 196 

Plumbi Praeparata (Preparations of Lead) 196 

Cupri Prteparata (Preparations of Copper) 202 

Zinci Praeparata (Preparations of Zinc) 203 

Argenti Praeparata (Preparations of Silver) 206 

Bismuthi Praeparata (Preparations of Bismuth) 209 

Cerii Oxalas (Cerium Oxalate) 210 

Alumen (Alum) 211 

Aluminii Sulphas (Aluminium Sulphate) 212 

Alum- Waters 212 

Order VI. Stimulants 213 

Diffusible Stimulants 213 

Alcohol 213 

Vinum (Wine) 218 

Spiritus Vini Gallici (Brandy) 219 

Spiritus Frumenti ("Whiskey) 219 

Spiritus Sacchari (Rum) 219 

Spiritus Juniperi (Gin) 219 

Spiritus Myrciae (Spirit of Myrcia) 219 

Malt Liquors 219 

Extractum Malti (Extract of Malt) 219 

Ammoniae Praeparata (Preparations of Ammonia) 220 

Aromatics . 222 

Capsicum 223 

Piper (Black Pepper) -. 224 

Cinnamomum (Cinnamon) 225 

Myristica (Nutmeg) 225 

Macis (Mace) 225 

Caryophyllus (Cloves) 226 

Pimenta 227 

Oleum Cajuputi (Cajeput Oil) 227 

Zingiber (Ginger) 227 

Cardamomum (Cardamom) 228 

Pulvis Aromaticus (Aromatic Powder) 228 

Extractum Aromaticum Fluidum (Aromatic Fluid Extract) 228 

Calamus 228 

Gaultheria 230 



CONTENTS. xiii 

PAGE 

Aurantii Amari Cortex (Bitter-orange Peel) 231 

Aurantii Dulcis Cortex (Sweet-orange Peel) 231 

Those belonging to Nat. Ord. Labiatae 231 

Menthol 232 

Vinum Aromaticum (Aromatic Wine) 233 

Those belonging to Nat. Ord. Umbellifene 234 

Illicium (Star Anise) 234 

Vanilla 234 

Order VII. Sedatives 235 

Aconitum (Aconite) 235 

Veratrum Viride 241 

Veratrina (Veratrine) 244 

Pulsatilla (Pasque-flower) 246 

Arnica 2^7 

Phytolacca 247 

Staphisagria 248 

Antimonii Praeparata (Preparations of Antimony) 249 

Potassii Nitras (Potassium Nitrate) 253 

Sodii Nitras (Sodium Nitrate) 255 

Refrigerants 255 

Potassii Citras (Potassium Citrate) 255 

Liquor Ammonii Acetatis (Solution of Ammonium Acetate) .... 256 

Spiritus yEtheris Nitrosi (Spirit of Nitrous Ether) 257 

Acida VegetabiKa (Vegetable Acids) 257 

Order VIII. Spinants 259 

Excito-Motors . 260 

Nux Vomica 260 

Strychnina (Strychnine) 265 

Strychninae Sulphas (Strychnine Sulphate) 265 

Ignatia 266 

Hydrastis 266 

Rhus Toxicodendron (Poison-Oak) 267 

Cocculus Indicus 268 

Picrotoxinum (Picrotoxin) 268 

Ergota (Ergot) r ■ 269 

Ustilago . 274 

Gossypii Radicis Cortex (Bark of Cotton-Root) 275 

Digitalis 277 

Adonidin 282 

Strophanthus 283 

Sparteine 284 

Cimicifuga 285 

Depresso-motors 287 

Conium 287 

Physostigma 290 

Chloral 292 

Croton-Chloral-Hydrate 295 

Potassii Bromidum (Potassium Bromide) 296 

Aramonii Bromidum (Ammonium Bromide) 300 



xiv CONTENTS. 

PAGE 

Sodii Bromidum (Sodium Bromide) 300 

Lithii Bromidum (Lithium Bromide) 301 

Calcii Bromidum (Calcium Bromide) 301 

Zinci Bromidum (Zinc Bromide) 301 

Acidum Hydrobromicum Dilutum (Diluted Hydrobromic Acid) . . . 301 

Tabacum (Tobacco) 301 

Lobelia 304 

Acidum Hydrocyanicum Dilutum (Diluted Hydrocyanic Acid) . . . 306 

Potassii Cyanidum ( Potassium Cyanide) 309 

Oleum Amygdalae Amarae (Oil of Bitter Almonds) 310 

Syrupus Amygdalae (Syrup of Almonds) 310 

Amyl Nitris (Amyl Nitrite) 310 

Nitroglycerinum (Nitroglycerin) 312 

Potassium Nitrite * . . 314 

Sodium Nitrite 314 

Gelsemium 314 

Woorara 316 

Viburnum „ 318 

Grindelia 319 

Sumbul 320 

Class II.^-Eccritics 321 

Order I. Emetics . . ■ 321 

Vegetable Emetics 322 

Ipecacuanha (Ipecac) 322 

Sanguinaria 326 

Apomorphinae Hydrochloras (Apomorphine Hydrochlorate) .... 328 

Sinapis (Mustard) 329 

Tobacco 329 

Lobelia 329 

Mineral Emetics 329 

Order II. Cathartics 329 

Laxatives 330 

Tamarindus (Tamarind) 331 

Manna 331 

Viola Tricolor 332 

Cassia Fistula ^^ 

Oleum Olivae (Olive-Oil) ^33 

Oleum Amygdalae Expressum (Expressed Oil of Almond) ^^^ 

Oleum Ricini (Castor-Oil) 33^ 

Sulphur 336 

Potassa Sulphurata (Sulphurated Potassa) 338 

Sulphur -Waters (North American) 338 

Sulphur-Waters (European) 339 

Saline Cathartics • 340 

Magnesia 342 

Magnesia Ponderosa (Heavy Magnesia) 342 

Magnesii Carbonas (Magnesium Carbonate) 342 

Magnesii Sulphas (Magnesium Sulphate) 343 

Liquor Magnesii Citratis (Solution of Magnesium Citrate) 344 



CONTENTS. 



Magnesii Citras Granulatus (Granulated Magnesium Citrate) .... 344 

Sodii Sulphas (Sodium Sulphate) 344 

Mangani Sulphas (Manganese Sulphate) 345 

Sodii Phosphas (Sodium Phosphate) 345 

Sodii Pyrophosphas 346 

Potassii Sulphas (Potassium Sulphate) 346 

Potassii Bitartras (Potassium Bitartrate) 346 

Potassii Tartras (Potassium Tartrate) 347 

Potassii et Sodii Tartras (Potassium and Sodium Tartrate) 347 

Saline Mineral Waters (North American) 348 

Saline Mineral Waters (European) 350 

Mild Acrid Cathartics 352 

Rheum (Rhubarb) . . 352 

Juglans 355 

Aloe (Aloes) 355 

Senna 357 

Leptandra 359 

Frangula <^$g 

Cascara Sagrada 360 

Drastic Cathartics 360 

Jalapa (Jalap) 360 

Bryonia (Bryony) 362 

Podophyllum 363 

Chelidonium . " 365 

Iris 366 

Euonymus 367 

Scammonium (Scammony) 367 

Colocynthis (Colocynth) 368 

Cambogia (Gamboge) 370 

Elaterinum (Elaterin) 370 

Oleum Tiglii (Croton-Oil) 371 

Mercurial Cathartics . • . . . 373 

Enemata ... 374 

Order III. Diaphoretics 376 

Pilocarpus 377 

Alterative Diaphoretics 380 

Sarsaparilla t 380 

Guaiaci Lignum et Resina (Guaiacum Wood and Guaiac) 381 

Mezereum 383 

Menispermum 384 

Calendula 384 

Sassafras 384 

Stillingia 384 

Order IV. Diuretics 385 

Potassii Acetas (Potassium Acetate) 386 

Sodii Acetas (Sodium Acetate) 386 

Scilla (Squill) 387 

Colchicum 389 

Oleum Erigerontis (Oil of Erigeron) 393 



xvi CONTENTS. 

PAGE 

Apocynum 393 

Taraxacum 395 

Triticum (Couchgrass) 396 

Juniperus (Juniper) 396 

Scoparius 397 

Cantharis (Cantharides) 397 

Order V. Blennorrhetics 398 

Senega 398 

Quillaia 400 

Allium (Garlic) ' 401 

Scilla (Squill) 402 

Terebinthina (Turpentine) 402 

Chian Turpentine 404 

Oleum Terebinthinae \ Oil of Turpentine) \ . 404 

Pix Liquida (Tar) 406 

Resina (Resin) 407 

Copaiba 407 

Cubeba (Cubeb) 410 

Oleum Santali (Oil of Santal) 411 

Matico 412 

Pareira 413 

Buchu '. . 413 

Uva Ursi 414 

Chimaphila 415 

Myrrh a (Myrrh) 416 

Benzoinum (Benzoin) 417 

Styrax (Storax) 418 

Balsamum Peruvian urn (Balsam of Peru) 419 

Balsamum Tolutanum (Balsam of Tolu) 419 

Order VI. Emmenagogues ... 420 

Sabina (Savine) 421 

Oleum Rutae (Oil of Rue) . . . .421 

Tanacetum (Tansy) 422 

Apiol 423 

Polygonum Hydropiperoides (Water- Pepper) 423 

Class III. — Hematics 424 

Order I. Hematinics 424 

Order II. Alteratives 424 

Hydrargyri Praeparata (Preparations of Mercury) 425 

Auri et Sodii Chloridum (Auric and Sodium Chloride) 444 

Iodum (Iodine) 445 

Potassii Iodidum (Potassium Iodide) 449 

Ammonii Iodidum (Ammonium Iodide) 451 

Sodii Iodidum (Sodium Iodide) 451 

Sulphuris Iodidum (Sulphur Iodide) .* . 452 

Oleum Morrhuae (Cod-liver Oil) 452 

Arsenii Praeparata (Preparations of Arsenic) 455 

Calcii Phosphas Praecipitatus (Precipitated Calcium Phosphate) ... 464 

Syrupus Calcii Lactophosphatis (Syrup of Calcium Lactophosphate) . 465 



CONTENTS. xvii 



PAGE 



Calcii Hypophosphis (Calcium Ilypophosphite) 465 

Potassii Hypophosphis (Potassium Hypophosphite) 465 

Sodii Hypophosphis (Sodium Hypophosphite) 465 

Syrupus Hypophosphitum (Syrup of Hypophosphites) 466 

Syrupus Hypophosphitum cum Ferro (Syrup of Hypophosphites with 

Iron) 466 

Calcii Chloridum (Calcium Chloride) 466 

Ammonii Chloridum (Ammonium Chloride) 467 

Ammonii Phosphas (Ammonium Phosphate) 468 

Potassii Chloras (Potassium Chlorate) 469 

Sodii Chloras (Sodium Chlorate) 470 

Potassii Bichromas (Potassium Bichromate) 470 

Order III. Antacids 471 

Potassii Praeparata (Potassium Preparations) 473 

Sodii Praeparata (Sodium Preparations) 475 

Alkaline Mineral Waters (North American) 478 

Alkaline Mineral Waters (European) 479 

Lithii Praeparata (Lithium Preparations) 480 

Lithian Mineral Waters 481 

Ammonii Praeparata (Ammonium Preparations) 482 

Magnesii Praeparata (Magnesium Preparations) 482 

Calcii Praeparata (Calcium Preparations) 482 

Calcareous Waters (North American) .... 484 

Calcareous Waters (European) 484 

Class IV. — Topical Medicines. 

Order I. Antiseptics and Antipyretics 485 

Potassii Permanganas (Potassium Permanganate; 486 

Aqua Chlori (Chlorine Water) 487 

Calx Chlorata (Chlorinated Lime) 488 

Liquor Sodae Chloratae (Solution of Chlorinated Soda) 488 

Hydrargyri Chloridum Corrosivum (Mercuric Chloride) 489 

Bromum (Bromine) 490 

Iodum (Iodine) ■ . . . . 490 

Hydrargyri Iodidum Rubrum (Mercuric Iodide) 490 

Acidum Sulphurosum (Sulphurous Acid) 490 

Sodii Sulphis (Sodium Sulphite) 491 

Sodii Bisulphis (Sodium Bisulphite) 491 

Sodii Hyposulphis (Sodium Hyposulphite) 491 

Potassii Sulphis (Potassium Sulphite) 491 

Magnesii Sulphis (Magnesium Sulphite) 491 

Sulphides 492 

Calx Sulphurata (Sulphurated Lime) 492 

Acidum Boricum (Boric [Boracic] Acid) 492 

Sodii Boras (Sodium Borate — Borax) 494 

Derivations of the organic radical, Phenyl 494 

Phenyl Hydride (Benzine — Benzol) 497 

Acidum Carbolicum (Carbolic Acid) 497 

Sodii Sulpho-carbolas (Sodium Sulpho-carbolate) 502 

Creasotum (Creasote) 502 



iii CONTENTS. 

PAGE 

Nitro-benzine 504 

Aniline 504 

Acetanilide (Antifebrin) 504 

Exalgine (Methylacetanilide) 507 

Acidum Benzoicum (Benzoic Acid) 508 

Sodii Benzoas (Sodium Benzoate) 509 

Ammonii Benzoas (Ammonium Benzoate) 509 

Resorcin 510 

Hydroquinone (Hydrochinone — Para-oxy phenol) 512 

Pyrocatechin (Ortho-oxyphenol) . . . , 512 

Acidum Salicylicum (Salicylic Acid) 512 

Sodii Salicylas (Sodium Salicylate) 515 

Lithii Salicylas (Lithium Salicylate) 515 

Salol * . . 515 

Naphthaline 517 

Naphthol 519 

Pyridine 520 

Chinoline 522 

Kairine 5 22 

Thalline 524 

Antipyrine 526 

Antiseptic Oils '..... 528 

Remedies used chiefly for topical antisepsis 528 

Iodoformum (Iodoform) 528 

Aristol 531 

Iodol 533 

Thymol 535 

Icthyol 535 

Dermatol 537 

Carbo Ligni (Charcoal) 537 

Order II. Irritants '. 538 

Rubefacients . . 538 

Sinapis (Mustard) 539 

Capsicum 542 

Oleum Terebinthinae (Oil of Turpentine) 542 

Linimentum Ammonioe (Liniment of Ammonia) 542 

Pix Burgundica (Burgundy Pitch) 542 

Pix Canadensis (Canada Pitch) 543 

Epispastics 544 

Cantharis (Cantharides) 4 545 

Cantharis Vittata (Potato-Fly) 550 

Aqua Ammoniae (Water of Ammonia) .... 550 

Suppurants 551 

Oleum Tiglii (Croton Oil) 551 

Unguentum Antimonii (Antimonial Ointment) 551 

Escharotics 551 

Argenti Nitras Fusus (Fused Silver Nitrate) 552 

Potassa 552 

Potassa cum Cake (Potassa with Lime) 553 



CONTENTS. xix 

PAGE 

Soda 553 

Acidum Chromicum (Chromic Acid) 553 

Acidum Arseniosum (Arsenious Acid) 554 

Bromum (Bromine) 554 

Zinci Chloridum (Zinc Chloride) 555 

Liquor Hydrargyri Nitratis (Solution of Mercuric Nitrate) 555 

Potassii Bichromas (Potassium Bichromate) 555 

Acida Mineralia (Mineral Acids) 555 

Sapo Viridis (Green Soap) 556 

Chrysarobinum (Chrysarobin) 557 

Order III. Demulcents * . . 558 

Cataplasmata (Poultices) 559 

Aqua (Water) 560 

Acacia 561 

Tragacantha (Tragacanth) 563 

Linum (Flaxseed) 564 

Oleum Gossypii Seminis (Cotton-seed Oil) 565 

Ulmus (Slippery-Elm Bark) 565 

Sassafras Medulla (Sassafras Pith) 566 

Althaea (Marshmallow) 566 

Oleum Sesami' (Oil of Benne) 567 

Cydonium (Quince Seed) 567 

Glycyrrhiza (Liquorice Root) 567 

Glycyrrhizinum Ammoniatum (Ammoniated Glycyrrhizin) 568 

Extractum Glycyrrhizse (Extract of Liquorice) 569 

Lycopodium . 569 

Cetraria (Iceland Moss) 570 

Chondrus (Irish Moss) 571 

Amylum (Starch) 572 

Glyceritum Amyli (Glycerite of Starch) 573 

Ichthyocolla (Isinglass) , 573 

Animal Fats « 573 

Adeps (Lard) 574 

Lanolin 574 

Sevum (Suet) 575 

Cetaceum (Spermaceti) 575 

Cera (Wax) • 575 

Acidum Oleicum (Oleic Acid) 575 

Oleum Theobromae (Oil of Theobroma) 576 

Glycerinum (Glycerin) 577 

Petrolatum 578 

Pyroxylinum (Pyroxylin) 579 

Collodium (Collodion) 579 

Liquor Gutta Perchae (Solution of Gutta Percha) 580 

Liquor Sodii Silicatis (Solution of Sodium Silicate) 581 

Saccharum (Sugar) 581 

Mel (Honey) 582 

Saccharum Lactis (Sugar of Milk) 582 

Saccharin 582 



: CONTENTS. 

PAGE 

Order IV. Coloring Agents 583 

Crocus (Saffron) 583 

Santalum Rubrum (Red Saunders) 584 

Coccus (Cochineal) 584 

Order V. Anthelmintics 584 

Spigelia 585 

Chenopodium 587 

Santonica ' 588 

Santoninum (Santonin) 588 

Sodii Santoninas (Sodium Santoninate) 589 

Azedarach 589 

Aspidium 590 

Granatum (Pomegranate) 591 

Oleum Terebinthinae (Oil of Turpentine) 592 

Calomel 592 

Brayera (Koosso) 592 

Kamala 592 

Pepo (Pumpkin Seed) 593 

Appendix — Signs and Abbreviations 594 

Index _ 596 

Index of Diseases and Remedies . . . . , 612 



Materia Medica and Therapeutics. 



I. The agents employed in the treatment of diseases are denomi- 
nated Remedies, and the branch of medicine which is devoted to 
their consideration is termed Materia Medica. Remedies may be 
divided into Hygienic, Mechanical, Imponderable, and Pharma- 
cological, agents. 

II. By Therapeutics is meant the application of remedies to the 
treatment of disease. It includes, in a broad sense, the use of 
remedial measures of all sorts, as climate, diet, baths, nursing, cloth- 
ing, massage, electricity, and physical exercise. Therapeutics may 
be divided into rational and empirical. 

By rational therapeutics is meant the administration of a remedy 
for therapeutical purposes based upon what is actually known of its 
physiological action. Thus it is given beforehand with a definite 
idea of what it is to accomplish and consequently when so taken 
antagonizes a particular pathological condition with some degree of 
certainty. The use of digitalis in the relief of mitral regurgitation 
is an example of rational therapeutics, since this drug is well known 
to prolong the diastole and energize the systole of the heart, thus 
more completely filling and emptying its cavities and consequently 
overcoming the obstruction to the regular flow of the blood: hence 
its exhibition is indicated on rational grounds. 

Empirical therapeutics consists in the administration of reme- 
dies at haphazard because previous experience has demonstrated 
their efficiency in certain affections, while the explanation as to 
their action remains totally obscure. The exhibition of opium as 
an anodyne and hypnotic is an example of empirical therapy. 
That it deadens pain and induces sleep is well understood, but the 
way in which it does so is completely unknown. The majority of 
drugs are employed empirically. 

Hygienic Remedies are usually treated of in works specially 
devoted to the subject. 

3 33 



34 MATERIA MEDIC A AND THERAPEUTICS. 



PART I. 

MECHANICAL REMEDIES. 

Mechanical Remedies belong chiefly to Surgery. A few 
agents of this class being, however, employed in the practice of 
medicine, are included in the Materia Medica. They are Blood- 
letting (general and local), Setons, Issues, Bandages, Friction, 
Acupuncture, and Aspiration. 

1. General Blood-letting is performed principally by vene- 
section or phlebotomy, which is usually practiced on the median- 
cephalic or basilic veins of the arm — sometimes also on the external 
jugular and other veins. From the veins at the elbow it is done by 
passing a ligature above the point selected, the patient being in the 
sitting posture, and making an incision in the most prominent vein 
ample enough to permit f5ij-iij of blood to escape per minute, and 
allowing it to flow until syncope approaches. To stop the flow, re- 
move the ligature, apply a compress, and place the patient in the 
recumbent posture. Arteriotomy is occasionally resorted to, on the 
temporal artery, in cerebral affections. 

Medicinal Uses. — Blood-letting is employed to moderate vas- 
cular excitement, reduce inflammatory action, alter the quality of the 
blood (diminishing the proportion of fibrin, albumen and salts), 
relieve congestion, allay spasm and pain, relax the muscular system, 
promote absorption, arrest hemorrhage, remove stasis, and prevent 
cell proliferation and inflammatory effusions, and for these purposes 
it has long been considered a valuable therapeutical resource. So 
powerful and exhausting an agent is, however, always to be resorted 
to with caution and discrimination ; is not to be unduly repeated, 
even in inflammatory cases ; and is seldom or never proper in dis- 
ease of a typhoid tendency, or where a tubercular diathesis is 
suspected, or in extreme infancy and old age. It is indicated in 
inflammations and conditions of sthenic type occurring in robust 
adults, and accompanied by a full, bounding, tense pulse, and should 
only be resorted to early in the case, before inflammatory effusions 
have taken place. Under these circumstances it may be of service 
to abort apoplexy and to relieve puerperal eclampsia. 



MECHANICAL REMEDIES. 35 

2. The Local Abstraction of Blood is practiced by means 
of leeches, cups, and scarifications. When a leech is applied between 
the inflamed area and the heart the blood-current is accelerated, 
stasis removed or prevented, as is also the migration -of cells and 
the effusion of serum. Scarifications produce the same results in a 
less degree, and also give vent to effused fluids. The leech (liirudd) 
is an annulated aquatic worm, with a flattened body, tapering 
toward each end and terminating in circular flattened disks, which 
is found throughout Europe, America and India. The European 
leech (//. medicinalis, termed also sanguisuga officinalis) is of a black- 
ish or grayish-green color on the back, from two to three or four 
inches in length, and is characterized by six longitudinal dorsal 
ferruginous stripes, the four lateral ones being interrupted or tessel- 
lated with black spots. It draws about f§ss. The American leech 
(It. decora) is usually from two to three inches long, and is of a deep 
green color, with three longitudinal dorsal rows or square spots. 
Both the imported and indigenous leech are employed in this 
country, but the latter makes a smaller incision, and is preferable in 
infantile cases. It takes about f5j. When the discharge of blood 
from leech-bites is excessive, it may be arrested by pressure, com- 
presses of lint, the application of alum, creasote, solution of iron 
subsulphate, and other styptics, or by cauterizing the wound with 
silver nitrate or a red-hot probe ; and if these means fail, the lips of 
the wound may be sutured. 

When blood is drawn by leeches, its continuous flow may be 
promoted by the application of warm fomentations to the wounds. 

In the operation of cupping, cupping-glasses and a scarificator 
are employed. The removal of atmospheric pressure, by the appli- 
cation of glasses partially exhausted of air, which may be done by 
igniting a little alcohol in each cup immediately before its applica- 
tion, produces a determination of blood to the capillaries of a part, 
which is afterward readily drawn by scarification. When blood is 
not abstracted, the operation is termed dry cupping, and is a valua- 
ble revulsive agent. The topical abstraction of blood by leeches 
and cut-cups combines the advantages of depletion and revulsion. 
Cups are generally preferable in internal inflammations, from their 
more decided revulsive influence. Both the dry and wet cups are 
employed in a wide range of affections in which the local abstraction 
of blood and a revulsive action may seem necessary to influence 
distant organs, as in the first stage of acute Bright' s disease, as well 



36 MATERIA MEDICA AND THERAPEUTICS. 

as in the chronic forms ; here the cups should be applied over the 
renal region. Wet-cups are also of service in uremic convulsions 
and iiremia. Leeches are employed in the early stages of external in- 
flammations where cups would obviously be inadmissible and in 
infantile cases. They are applicable to the treatment of forming 
abscess, adenitis and bubo, applied near or over the affected part or 
glands, to relieve cerebral hyperemia, uremic convulsions, metritis and 
endometritis (to cervix), keratitis (temple), myelitis (spine), and myr- 
ingitis (mastoid). As leech-bites make scars, they should be cau- 
tiously applied over an exposed part, as the female face ; nor should 
they be used where there is much loose connective tissue, as the 
scrotum and eyelid ; over a superficial vessel or nerve ; seldom over 
the seat of morbid action, nor in the vicinity of locally infected 
wounds, as venereal ulcers. 

Scarifications are slight incisions, as with a scalpel, made upon in- 
flamed parts to relieve the engorged capillary vessels. They are 
employed with benefit in acute tonsillitis, and in conjunctivitis with 
much chemosis and swelling. They are also serviceable in the 
treatment of acne indtcrata by puncture and should be followed 
by a stimulating lotion. Made upon the tympanic membrane and 
avoiding perforation a few cuts afford relief in acute myringitis. As 
scarifications given vent to effused fluids they may be used to let 
out the superficial dropsy of chronic Bright } s disease. 

3. Setons (setacea) and Issues (fonticuli) were employed when 
a permanent counter-irritant effect was desired. They are now not 
much used. 

4. Bandages are employed, in the practice of medicine, to pro- 
mote the absorption of dropsical effusions, and solid inflammatory 
exudations. For the same purpose strips of adhesive plaster may 
be applied to the chest, in clwonic pleurisy and empyema, in the man- 
ner in which they are employed in the treatment of fractured ribs. 
The elastic bandage is used to promote the absorption of fluid in 
diseases of the bursa. 

5. Frictions are used as revellents and as local stimulants. 
They may be employed either with the dry hand or with horse-hair 
gloves, or with liniments. The latter, applied with a sponge, are 
serviceable in lumbago, sciatica, chronic rheumatism, and affections of 
the joints ; rubbed on the chest in acute bronchitis they often afford 
relief. As a local stimulus in anidrosis, frictions tend to re-establish 
the secretion of the sweat. 



MECHANICAL REMEDIES. 37 

6. Acupuncture consists in the introduction into the body of 
fine, well-polished, sharp-pointed needles; they are introduced by a 
rapid rotary motion. This is a remedy occasionally used though a 
painful one, in chronic rheumatism , neuralgia, balanitis and paralysis. 
By the use of insulated needles a galvanic current may be conveyed 
to deeply-seated nerves. For purposes of counter-irritation a form 
of acupuncture is now used termed Baunscheidtismus. In this, an 
instrument is employed consisting of a heavy disk about half an 
inch in diameter, having inserted in it about twenty-five sharp 
needles, each about nine-sixteenths of an inch in length. To this 
disk is attached a strong wire spiral spring five and a half inches in 
length, and the other extremity of the spring is inserted in an elon- 
gated spindle-shaped handle, the spring and needles being contained 
in a cylinder, with the handle attached. In applying the instrument 
the open extremity of the cylinder is placed upon the skin ; the 
handle is drawn up, and when this is suddenly loosed the needles 
are driven into the skin, the punctures being afterward rubbed with 
diluted croton oil or other irritant. 

7. Pneumatic Aspiration is the employment of an instrument 
termed an Aspirator (invented by Dieulafoy) for the removal by 
suction of pathological fluids. 

The aspirator consists of: — 

1. A glass-bottle or reservoir, A, mounted with a two-way 

stop-cock, B, and having an opening at the bottom for the 
insertion of the tube, C. 

2. An exhausting syringe, D, with elastic connecting-tube, H. 

3. A tubular needle, E, to be attached to the reservoir by an 

india-rubber tube, F. 

A syringe and stop-cock for injecting astringents or other fluid 
is supplied if desired. The stop-cock is, in such cases, fixed to the 
tube F at its junction with the stop-cock B. Thus the tube can be 
detached from the aspirator without any chance of air entering the 
morbid cavity. 

Directions for Use. — Adjust the aspirator as figured in the 
diagram, with the stop-cock B turned vertically, that is, open to the 
bottle ; close the stop-cock in the tube C, and form a vacuum by a 
few upward and downward movements of the piston of the exhaust- 
ing syringe D. 

Insert one of the needles beyond the two eyes, attach tube F 
to it, turn the stop cock B toward the needle, namely, horizontally, 



38 



MATERIA ME DIC A AND THERAPEUTICS. 




IMPONDERABLE REMEDIES. 39 

and continue the insertion of the needle until fluid is seen to flow 
through the short glass-tube G into the reservoir. 

To empty the latter, turn the stop-cock B vertically, detach the 
syringe tube, and open the stop-cock in the tube C. 

The presence of fluid having been established by the use of 
one of the fine needles, it is recommended, for more quickly emp- 
tying the cavity, to use one of the larger needles or trocars. 

The introduction of the needle into the tissues requires some 
precautions. In place of endeavoring to penetrate by pressure, as 
with an ordinary trocar, it is preferable to combine pressure with 
rotation, by taking the needle in the forefinger and thumb and roll- 
ing it between them. Such a manoeuvre is rendered necessary by 
the extreme fineness of the needle, which would be liable to bend 
or twist if driven in by direct pressure. Before using a needle it is 
well to be assured of its permeability. 

Aspiration has been employed with safety and success, when 
other means have failed, in the removal of intrathoracic effusions as 
in chronic pleurisy, empyema, and pericarditis ; of the fluid of hydro- 
cephalus, spina bifida, ascites, hydrothorax, cysts, abscess of the liver, 
hydrocele, synovitis ; diseases of the bur see, and dropsical effusions gen- 
erally as those of chronic Bright s disease. It is also applicable to the 
diagnosis and treatment of morbid fluids. Its use, too, avoids the 
formation of a disfiguring scar, as in the withdrawal of pus from a. bubo. 

Aspiration should be done under strict antiseptic precautions. 



PART II. 

IMPONDERABLE REMEDIES. 

Under this head are included Light, Heat, Cold, Electricity, 
and Massage. 

1. Light {Lux) exercises an important influence in the organ- 
ized world as a vivifying stimulus. It is useful as a therapeutic 
agent, in diseases dependent on imperfect nutrition and sanguifica- 
tion ; and the exposure of the surface of the body to its action, as 
far as nudity is compatible with proper warmth, promotes the regu- 
lar development and strength of the organs. On the other hand, 
in many diseases the action of light is injurious, and darkness is 
resorted to as a sedative and tranquillizing agent. 



40 MATERIA MEDIC A AND THERAPEUTICS. 

2. Heat (Calor), applied to the human system in moderate 
amount, acts, both locally and generally, as a stimulant ; in intense 
degree it destroys vitality and organization. It is employed as a 
local excitant and revulsive, by means of hot bottles, hot bricks, and 
the hot foot-bath, as in collapse ; in facial palsy when due to cold ap- 
plied to the side of the head; and as an application to painful and 
inflamed parts in the form of elastic bags containing hot water; and 
of poultices and fomentations. Hot water introduced into the audi- 
tory canal will often stop the pain of that symptomatic condition 
known as earache ; injected into the uterus it is a method of treat- 
ment sometimes of value in endometritis, and is likewise occasionally 
used in metritis ; and as an injection in female gonorrhoea. As a 
general application heat is resorted to in the form of the water-bath 
and vapor-bath. Contraindications : All baths are unsuitable for 
the asthenic, and are to be avoided by those affected with fatty 
heart, and who have a tendency toward apoplexy. Cold baths are 
particularly to be shunned if they cause chilliness afterward. The 
zvarm bath, at a temperature of from 92 to 98 F. is used as a relaxant 
in dislocations, hernice, spasm, infantile convulsions, croup, etc., and 
also for its action on the joints in rheumatic, and upon the skin, in 
chronic cutaneous affections — rheumatic arthritis and anidrosis, for 
example. The hot bath, which may be either the plunge hip or sitz, 
has a temperature of from 98 to 11 2° F., or even higher, and is a 
powerful excitant in cases of exhaustion and asphyxia ; it alleviates 
the strangury of acute cystitis and gonorrhoea, and is employed also 
in old paralytic and rheumatic cases. Hot water, introduced with a 
Davidson's syringe, is an efficient styptic in uterine hemorrhage ; 
injected into the vagina before an operation on the perineum or 
cervix, or applied to wounds during a surgical operation, it is a 
good means of avoiding hemorrhage. In amenorrhcea hot sitz- 
baths, taken a few days before the expected period, are sometimes 
efficacious in re-establishing the menstrual flow. The chafing of 
tender feet may be avoided by soaking them in hot water containing 
a small lump of potassium nitrate. Immersion in the hot bath is 
one of the best means of alleviating the severe pain attending the 
passage of biliary and renal calcidi, to prevent an attack of laryngis- 
mus stridulus, to facilitate the urinary flow combined with a full 
dose of opium in retention, and lastly as the plunge or hip in the 
management of endometritis. Tepid alkaline baths are serviceable 
to soften and remove the crusts and scales of various cutaneous 



IMPONDERABLE REMEDIES. 41 

affections, for instance, ecthyma i prickly heat and psoriasis, to which 
may be added a little carbolic acid. The hot-air-bath, at a temper- 
ature of from 98 to 130 F. is useful as an excitant, diaphoretic 
and revellent, and is employed in cases of internal congestion, to 
produce vicarious action from the skin, where the secretion from 
other organs, as the kidneys, is more or less suspended, notably in 
chronic Bright 's disease, and in rheumatic and cutaneous affections, 
particularly that of anidrosis, for the purpose of re-establishing the 
secretion of the sweat. 

When desirable to employ hot baths for a prolonged period, 
conjoined with change of climate and scene, those of the Hot 
Springs, Arkansas ; Las Vegas, New Mexico ; and Bath County 
Hot Springs, Virginia, should not be lost sight of. These waters 
are often beneficial when other measures have failed in gout, chronic 
rheumatism, stiffness of the joints, paralysis, without organic lesion, 
secondary and tertiary syphilis and neuralgia. They render aid, too, 
in such cutaneous affections as lichen, psoriasis, phthiriasis, and 
chronic eczema. The temperature of the Arkansas Springs varies 
from 93 to 150 Fahr., and there are 57 springs from which the 
thermal waters flow in abundance. They contain small quantities 
of mineral matter, but only to the extent of gr. y^ to the gallon, 
composed chiefly of calcium carbonate and silica. The temperature 
of the Las Vegas Springs ranges .from 123° to 130 Fahr.; the 
mineral constituents of this spring being principally sodium chlo- 
ride and sulphate. The Bath Springs vary from ioo° to 106 
Fahr. Experience has proven that the waters of the Hot Springs 
of Arkansas are injurious in maladies of the brain, heart and lungs. 

The destructive agency of heat is resorted to for the purpose 
of vesication, as by the application to the skin of the metallic plate 
heated to 21 2° by immersion in boiling-water; and of cauterization, 
by the employment of red-hot iron, or of moxa. Hot iron (known 
as the actual cauter)^) is used chiefly as a styptic, but also as a 
revulsive as when applied to the spine in spinal irritation. The 
term moxa is applied to small masses of combustible matter (as 
cotton-wool), which are burnt slowly in contact with the skin, with 
a view to a revulsive effect in deep-seated inflammations, nervous 
affections, etc. 

3. Cold (Frigus). — The application of cold to living bodies 
produces a reduction of the temperature and volume of the parts, 
with contraction of the blood-vessels and other tissues, and suspen- 



42 MATERIA MEDIC A AND THERAPEUTICS. 

sion of the secretions and exhalations. The application of exces- 
sive or prolonged cold is followed by torpor and death of the 
parts. When it is applied in moderation and for a short period, 
reaction generally takes place, with a return and even increase in 
temperature, volume, color and sensibility. 

Cold is employed therapeutically, with a view to both its pri- 
mary and secondary effects. The primary action of cold is used : 
i. To lessen vascular and nervous excitement and preternatural 
heat, as by the use of cold lotions and spongings in fevers, the ice- 
cap in cerebral affections, the shower-bath in insanity, the bladder 
filled with ice to the spine in epilepsy, the ether spray to the spine 
in chorea, etc. 2. To constringe the tissues, promote the* coagula- 
tion of the blood and lessen the volume of parts ; hence the local 
application of ice- or cold water to abate inflammation and check 
hemorrhage. 3. To produce local ancesthesia in surgical operations, 
by means of a freezing mixture topically applied. 

The secondary effects of cold are obtained by the employment of 
a less intense degree of cold. They are resorted to: 1. To invig- 
orate the system, as with the cold shower-bath and plunge-bath. 
2. To rouse the system, as by cold affusions in coma, asphyxia, 
syncope, and the narcotism from opium, chloroform, hydrocyanic 
acid, alcohol, etc. 3. In spasmodic diseases, as laryngismus stri- 
dulus, chorea, etc. 4. To recall the vital properties to frost-bitten 
parts, as chilblain. 5. To effect local excitation, as by the applica- 
tion of the cold douche to rheumatic and paralyzed limbs. 

The cold bath, or packing in a cold wet sheet, at 6o°-70° F., 
is employed with much advantage in sunstroke, and in fevers where 
the temperature of the body is very high, as scarlet fever, typhoid 
fever, acute rheumatism, and, generally, to reduce excessive hyper- 
pyrexia. When the cold wet sheet is employed, it should be well 
wrung out of cold water, wrapped round the patient, and all envel- 
oped in a thick blanket. 

The ice-bag is sometimes applied along the spine in convul- 
sive diseases, as epilepsy, tetanus and infantile convidsions, as well as 
spinal irritatioji and myelitis, and over the kidneys in hematuria. 

Compresses, wrung out of cold water or the ice-bag, are efficient 
local applications in relieving pain, as when applied to the head in 
cerebral hyperemia and meningitis, and to antagonize the inflammation 
of sprains and synovitis. Bathing the eyes frequently in cold water 
will allay photophobia as that of keratitis and conjunctivitis. 



IMPONDERABLE REMEDIES. 43 

Cold liquids and ice are taken into the stomach as refrigerants in 
fevers, the latter to allay the thirst of cholera, cJiolera infantum and 
peritonitis. They are introduced into the rectum and vagina to check 
hemorrhage and allay irritation ; and cold water, injected into the 
impregnated uterus, is among the most certain means of inducing 
premature delivery. Chordee may be checked by the application of 
a bottle of ice-cold water to the perineum. Baths are also useful 
in promoting the elimination of mineral poisons, as lead and 
mercury. 

4. Electricity (Electricitas), from rjZexzpov, amber. " Electricity is 
now regarded as a force co-related to the other great forces of nature 
— heat, light, etc. — and, like them, is simply a mode of motion — a 
force of vibration." (Beard and Rockwell.) The electric current 
acts as an excitant to the nerves, both of sensation and motion. It 
influences also to some extent the secretions, through its action on 
the nerves distributed to the secreting organs ; it may promote the 
function of absorption, through an effect on the absorbents ; and it 
affects the circulation by inducing contractions of the heart and of 
the coats of the vessels. Faradization of the peripheral ends of the 
cut pneumogastrics stops the action of the heart ; of the central 
ends, it causes retarded action and reduced blood-pressure. A power- 
ful charge of electricity produces violent and frequently fatal effects 
on the central nervous system. 

For medical purposes electricity is obtained from three 
sources : — 

i. Friction or Static electricity. 

2. Galvanic electricity. 

3. Faradic, Induced, Magnetic or Voltao-Magnetic elec- 
tricity. 

Friction electricity may be applied in three modes : — 

1. By the electric bath, when the patient, placed upon an insu- 
lated stool and connected with the prime conductor of an electrical 
machine, is charged-wiih electricity. 

2. By a spark to a particular spot ; or, 

3. A shock through a charged Leyden jar may be directed 
through the part which it is desired to affect. 

Galvanism is that form of electricity which is developed by 
chemical decomposition, and is known as the continuous, voltaic, 
or battery current. It is characterized by relatively low intensity of 
action, but is developed in considerable quantity, and produces 



44 MATERIA MEDICA AND THERAPEUTICS. 

chemical and thermic results that are not reached by the friction 
electricity. When the current of any form of electricity is ap- 
plied to the body, it passes between the electrodes along the line 
of least resistance, which is for the most part a direct one. The 
continuous flow of the galvanic current through a motor nerve, 
unless the current be strong, is not followed by contractions of the 
muscles supplied by the nerve. Such contractions are only induced 
when the current is closed or broken. Upon the involuntary mus- 
cles, as the intestinal, the galvanic current causes slow and contin- 
uous contractions during the passage of the current. Hence the 
rationale of the use of galvanic electricity for the purpose of in- 
creasing peristaltic movements in constipation. The galvanic current 
stimulates the sensory nerves, causing a prickly sensation, the point 
of contact of the cathode with the skin being felt the most. When 
the current is much increased the sensation passes into a burning 
feeling which after a time diminishes at the anode. Upon the 
gustatory nerve the passage of the current through the tongue pro- 
duces a metallic taste. The precise effect of galvanism upon the 
brain is not well understood, but it evidently penetrates the cerebral 
substances, for when the positive electrode is applied to the occiput, 
and the negative upon the forehead, an increased blood-supply to 
the head follows. Should the current be of sufficient strength 
vertigo will ensue. Galvanism of the cord induces muscular con- 
tractions, hence it is inferred that the current penetrates within its 
substance, at least as far as the motor cells. 

Faradization, or Induced electricity, is applied by means of 
electro-magnetic machines, their principle depending on the passage 
of a battery-current through an insulated wire helix (primary coil) 
wrapped round a soft iron bar, which becomes magnetic by induc- 
tion. Around this helix a fine insulated wire is coiled (secondary 
coil), which has no connection with the battery or primary helix, 
and which receives electricity by induction from the latter. Closure 
of the current magnetizes the bar, which, in turn, attracts the rheo- 
tome, thus breaking the flow, the bar then becomes demagnetized, 
the rheotome flies back by its own elasticity, and in this way an 
interrupted current is obtained. The polarity of the induced cur- 
rent changes with each make and break of the circuit, and of course 
is inconstant, because its direction is constantly alternating ; hence 
no chemical action is set up. If the interruptions be rapid enough, 
they cause apparently continuous muscular contractions. 



IMPONDERABLE REMEDIES, 45 

The primary current is taken from the inner helix ; the secondary 
from the outer. The shocks from the primary are much the weaker. 
The electrodes are the means by which the positive and negative 
electricity emerge from the battery ; the positive pole, or anode, 
being connected with the negative element, and the negative pole, 
or cathode, with the positive element. A stabile application is one 
in which the electrodes are kept in a fixed position ; in a labile they 
are shifted from point to point. Before use they should be moistened 
to increase their conductivity, as the skin is a bad conductor. The 
larger the electrode the greater will be the conductivity of the skin; 
on the other hand, to electrilize the skin alone, small metal elec- 
trodes should be used. Magneto-electricity is inferior in chemical 
and thermal influence to galvanism, but it produces more marked 
muscular contractions, and a more decided action on both the sen- 
sory and motor nerves. It has been shown by DuBois-Reymond 
that it is not the sum total of the density of the current passing 
through a motor nerve that stimulates it, but that such stimulation 
is due to change of density. Now the faradic current is made up 
of numerous currents of short duration, which are closed and opened 
at each swing of the vibrator ; consequently the change of density 
is abrupt, and the more suddenly these changes take place, the 
stronger will be the muscular contractions. Upon the involuntary 
muscles the faradic current produces slower and more continuous 
contractions than upon the voluntary, the slower the interruptions 
the more powerful the contractions. It is by this peculiar action of 
diminishing the size of muscular fibre, that faradization becomes so 
serviceable in reducing the dimensions of the uterus after parturition. 
Upon the sensory nerves the faradic cu'rrent produces a prickly, 
smarting sensation with each break of the rheotome, varying in 
intensity with the strength of the current. The brain substance, as 
shown by Erb, is readily affected by galvanism from the exterior, 
for when the electrodes are applied to the mastoids, flashes of light 
and vertigo are experienced ; but, according to Althaus, the former 
phenomenon is due to excitation of the fifth nerve. 

Electricity is employed in medicine for diagnostic and thera- 
peutic purposes. Thus, in the diagnosis of spinal paralysis : when a 
muscle is merely separated from the influence of the spinal cord by 
destruction of its nerve, or by destructive disease of the cord at the 
origin of its nerve, it loses its electric irritability to all forms of elec- 
tric irritation. Diminution of electro-excitability is found in loco- 



46 MATERIA MEDIC A AND THERAPEUTICS. 

motor ataxy of long standing and in diseases affecting the white 
matter of the cord ; in transverse myelitis ; in spinal affections that 
come under the orthopaedic surgeon's hands ; and lastly in muscles 
out of use from fracture, chronic joint troubles, etc. In cerebral 
paralysis, on the other hand, there is no diminution in the contrac- 
tility of the paralyzed muscle by the electric current, and there may 
be even an increase. An increase, too, is sometimes noticed in the 
early stage of locomotor ataxy, and it is constantly found in certain 
kinds of spasm, as tetanus. In malingering, real may be distinguished 
from feigned paralysis, as, after railway accidents, faradization, by 
showing a marked difference in the contractility of the two sides, 
establishes the fact of an actual morbid condition. 

In facial palsy the diagnostic value of electricity is typically 
evinced. Thus, the muscles respond scarcely, or not at all, to the 
faradic current in this condition, while the galvanic current will 
induce normal, or nearly normal, contractions. 

In recent hysterical paralysis the contractility of the muscles is 
unimpaired. 

Medicinal Uses. — Electro-therapeutics remains yet on a basis 
more or less unsatisfactory. As a general statement its effects are 
not called in till other means have failed, consequently it is often 
given in conditions which no measures could benefit. Still, when 
correctly applied and limited to suitable cases, it is incontestably 
an agent capable of accomplishing much good. Electricity 
may be employed either to arouse or increase the action of a nerve 
or muscle, as in paralysis of sensation or of motion, to relieve the 
pain of the various neuralgice, and to counteract spasm, as torticollis 
and facial spasm, either tonic or clonic. For the latter galvanism 
is mostly used, the positive pole being connected with a large plate- 
electrode which is placed over the spastic muscles, while the nega- 
tive is applied over a neutral point in the median line of the body. 
It is chiefly available in cases of local or of purely functional palsy, 
as facial, and paralysis produced by alcohol, which are independent 
of central lesions ; or in lead palsy after the elimination of the lead from 
the system. In the latter condition, which usually affects the ex- 
tensors of the wrist and fingers, a good plan of treatment is to 
apply one large flat electrode over the junction of the cervical and 
dorsal vertebrae, the other to the sternum. The current should be 
sent in both directions, and when the polarity is changed it should 
be weak at first. It may be necessary, too, to galvanize separately 
the palsied muscles. 



IMPONDERABLE REMEDIES. 47 

In the treatment of facial palsy the positive pole of the gal- 
vanic current is to be placed over the point of exit of the nerve 
below the ear, the negative on the terminal nerve-filaments which 
should be applied labile to the motor points about the face with a 
small electrode and the current interrupted frequently. It ought to 
be just strong enough to produce moderate contractions. Should 
these be readily obtained the prognosis is good. Galvanism gives 
the most satisfactory results when the palsy is due to peripheral 
neuritis, caused, it may be, by an effusion into the nerve-sheath, the 
result of a blast of cold air upon the face. 

Lumbago , neuralgia , muscular and chronic rheumatism, and 
migraine are frequently benefited by a course of electricity. For 
the relief of neuralgia a good plan is to place the cathode over the 
origin of the diseased nerve, the anode to the seat of pain and a 
current of moderate power passed through for three or four minutes. 
Where there are distinct painful points the anode should be thor- 
oughly applied. Sudden interruptions of the current are to be 
avoided. If galvanism fail, the faradic current should be tried. 
While there are no positive indications as to choice of battery, 
Rockwell gives the following rule for making the selection : if pres- 
sure aggravate the pain, galvanism is indicated ; if not, faradism is 
the proper form. 

In the treatment of chronic rheumatism electricity is often suc- 
cessfully employed. Either of the three forms of current may be 
given. When the faradic battery is used, the current should be 
passed, gradually increased, through the seat of pain, two or three 
daily seances being allowable. If the galvanic form be the selection, 
the cathode should be applied to the painful spot. According to 
W. H. King static electricity is the most successful in the relief of 
this affection. 

In migraine a current of medium strength should be passed 
from the nape of the neck to the epigastrium ; in addition, a longi- 
tudinal current is to be sent through the head by applying the 
anode to the forehead or eye-lids, the cathode to the occiput. The 
seances may last from five to ten minutes. The best that can be 
said in favor of electricity in sick headache is that it is only pallia- 
tive, rarely curative. If galvanism fail, the faradic current should 
be tried. 

Galvanism in exophthalmic goitre has been successfully given. 
Beard and Rockwell's method for electrilizing the sympathetics, 



48 MATERIA MEDICA AND THERAPEUTICS. 

the usual points of application, is to place the cathode over the 
seventh cervical vertebra, the anode to the auriculo-maxillary fossa, 
and with the latter stabile and labile applications are to be made at 
the fossa and along the inner edge of the sterno-mastoid muscle. 
After this has been accomplished, the anode is to take the place 
occupied by the cathode and the latter applied to the solar plexus, 
through which points a strong current is to be passed for one or 
two minutes. 

In zvriter's cramp of recent origin, good results may be ex- 
pected from galvanism which should be employed in conjunction 
with massage and gymnastic exercise. The anode is to be applied 
to the middle cervical vertebrae, and the cathode over the affected 
muscles through which a current of moderate strength should be 
sent daily. The seances should last from five to fifteen minutes, 
care being taken to regulate the power of the current, for this as in 
other cases, to the needs and condition of the case. 

For the relief of sciatica, an affection often so obstinate, vari- 
ous plans of electrization both by galvanism and faradism are in 
vogue. One is to apply the cathode at the origin of the nerve with 
stabile applications of the anode in the vicinity of the pain ; or two 
small electrodes may be used to pass the current at short range 
through segments of the affected parts of the sciatic nerve ; or a 
large anodal plate may be applied to the sacrum, and with the 
cathode the current successively sent along the nerve and its pain- 
ful branches. Whatever be the plan adopted, it should be com- 
bined with suitable hygienic and medicinal measures. 

Though by no possible construction can electricity be regarded 
as a cathartic, yet by its peculiar excitant effect upon the involun- 
tary muscular fibre it sets up peristaltic action and so brings about 
an evacuation from the bowels ; hence it is advantageously applied 
for the relief of constipation. Place one electrode at the anus and 
with the other go over the abdomen, using a current as strong as 
can be borne, until intestinal peristalsis can be detected by applying 
the ear to the abdomen. The galvano-faradic is the best form, but 
the faradic will do. 

Spermatorrhoea, urinary incontinence, and impotence, when func- 
tional, are not infrequently amenable to relief by electrization. It 
may be employed by applying a large plate electrode to the lumbar 
or sacral regions, and with a disk electrode covered with soft sponge, 
make labile applications to the perineum, groins and genitals ; or the 



IMPOXDERABLE REMEDIES. 49 

current may be passed through the urethra to the perineum by 
introducing it with a Neuman sound-electrode, the bulb of which is 
brought into contact with the neck of the bladder. Moral treat- 
ment must not be lost sight of in the first named affection. In im- 
potence, should the testicles and penis be cold and relaxed the cur- 
rent may be advantageously sent through them. 

During the attack of angina pectoris successful results have 
been obtained with the galvanic current by placing the anode over 
the precordial region and going over the sympathetics and spine 
from the occiput downward with the cathode. The current should 
be weak at first and gradually increased. 

The management of hysteria with electricity meets with vary- 
ing success, but no method of treating this condition will be of 
avail unless supported by appropriate moral influences. According 
to King static electricity yields the best results, perhaps due to the 
mental effect produced by the brilliant spark. Electricity with 
other measures enters into the Weir Mitchell plan of treating 
neurasthenic disorders (see p. 52). 

In cerebral anemia faradization, one electrode the anode, brought 
in contact with the occiput and the cathode to the forehead, since 
experience proves that passed in this way the current causes an 
increased supply of blood to the head, has frequently been success- 
fully employed. Weak currents should at first be used and the 
body generally may be advantageously galvanized. 

Faradization is often satisfactorily given in apoplexy the cur- 
rent to be applied to the paralyzed muscles with galvanization to 
the damaged portion of the brain. The results are, however, quite 
uncertain. The time to begin the cerebral application will be about 
one month after the attack, and it should not be persevered in be- 
yond one week if no benefit be apparent. As the effect of the cur- 
rent upon the clot seems to be catalytic it should be passed through 
the brain in the direction where this is supposed to be located. The 
application of the positive pole should be mostly on the side of the 
lesion, but precise rules have not yet yet been formulated as to 
where it is best applied. 

Faradization deserves mention as digalactagogue. If there be evi- 
dent lack of development of the mammary glands it should be begun 
before pregnancy. When given at any period the current is to be 
passed through the breasts for about ten minutes. General faradiza- 
tion with other measures may likewise be called in to induce lactation. 
4 



50 MATERIA MEDICA AND THERAPEUTICS. 

But little can be said in favor of electricity in dermal thera- 
peutics, though good results are claimed for it in chronic eczema 
(Rothwell), one pole of the galvanic current being applied to the 
nerve supplying the diseased part, and with the other labile appli- 
cations are to be made to the eruption. In anemic and hysterical 
paralysis, as hysterical aphonia, static electricity is often very useful, 
and in amaurosis, under many circumstances, faradization will be of 
benefit. 

Electricity has also been prescribed as an emmenagogue, to 
produce uterine contraction in post-partnm hemorrhage, one pole to 
the abdomen over the uterus, the other to the lumbar region ; in 
testing for life or death ; and to promote the biliary secretion. 

In the form of galvanism, one pole to the rectum, the other 
over the abdominal tumor, electricity is employed to destroy the 
foetus in extra-uterine pregnancy, provided foetal life has not ad- 
vanced too far. It has also been advantageously used to promote 
the absorption of indurations and fibroid tumors. To accomplish 
this purpose there are two plans of application to select from, one 
being the passage of the current through the tumor by means of an 
electrode placed within the uterine canal; the other by introducing 
an electrode-needle into the tumor to which the battery is attached. 
By the former method a strong current must be used. Electro- 
magnetism is a powerful excitant in the coma of narcotic poisons, 
and in asphyxia generally it is probably the most active remedy 
that can be exhibited. 

Electrolysis. — " This is a term applied to the process of de- 
composing substances by electricity." It is used with decided suc- 
cess to remove superfluous hairs from the face and other parts. 
Pitzer recommends the following procedure: an ordinary galvanic 
battery of 10-15 cells is required, with a fine needle, which is 
attached to the negative pole. The needle is inserted within the 
hair-follicle and the current closed with the positive electrode, 
causing a stinging sensation at the point of insertion ; the hair 
should then be withdrawn with forceps ; thirty to fifty hairs can be 
removed at one seance. 

Electrolysis has been used in the treatment of internal aneurism, 
but with a measure of success only. One or more needles con- 
nected with the positive pole are inserted within the sac in the hope 
of forming a clot by the ensuing electrolytic action of the current 
on the blood. The negative pole is to be applied to the shoulder, 



IMPONDERABLE REMEDIES. 51 

the current turned on slowly, and the seance should last about 
twenty minutes. Statistics show that the smaller the artery the 
greater the chance of occlusion. The chief dangers are hemor- 
rhage and the detachment and drifting into the blood of coagula. 

In urethral stricture the galvanic current in a certain propor- 
tion of cases effects a cure. Mild currents must be employed and 
applied to the seat of constriction per the negative pole by means 
of conical-metal bulbs attached to bougies. 

Galvano-cauterv. — This is a method of cauterization in which 
a wire-loop or other suitable cauterant is heated by the galvanic 
current. Experiment has shown that the heat developed in a wire 
by a current is proportional to the squares of the quantity of elec- 
tricity flowing through it and to the resistance of the wire. 

Platinum, on account of its great resisting power, is the kind of 
wire selected. The chief advantages of the galvano-cautery are : 
easy application to inaccessible parts, absence of hemorrhage, and 
comparatively little pain. It is employed as a cauterant in various 
ways, as to stop hemorrhage during an operation, to remove the 
hypertrophied tissues in chronic nasal catarrh, etc. 

5. Massage. — This is a word derived from the Greek, fidoau), I 
knead; Arabic, mass, press softly. Massage has been in use by the 
ancients from time immemorial. It is now defined to mean a series 
of digital and manual movements applied to the body for therapeutic 
purposes, and by some authors is designated mechano-therapy. 
There are four kinds of movements in vogue, viz., Effleurage, Petris- 
sage, Tapotement, and Massage a friction. The first consists in 
gentle centripetal palmar stroking of the surface ; the second of 
picking up and kneading the soft parts with the fingers ; the third 
of percussion with the fingers, hands or knuckles ; the fourth of 
elliptical frictions in narrow circles. 

The art or act of massaging consists in the suitable combina- 
tion of these movements, and, in order to obtain their best thera- 
peutical effects, should only be employed under medical advice, and 
administered by an expert. Inasmuch as action and reaction are 
equal, an individual cannot massage himself; moreover, there is an 
extraneous mesmeric influence involved, so conducive to its effectual 
performance, that renders this impossible. 

Physiologically, massage produces a calming effect on the 
nervous system, stimulates the flow of the blood and lymph, affords 
gentle exercise to the muscles, facilitates absorption, and elevates 



52 MATERIA MEDICA AND THERAPEUTICS. 

the body temperature about 1°. It does, in a word, contribute to 
restoring the body to health by arousing to renewed and normal 
activity all the vital processes, and, unlike internal medication, is 
not followed by reaction, of whatever degree of severity. 

Medicinal Uses. — Massage is employed frequently with ad- 
vantage in a variety of obstinate affections where other measures 
have proved unsuccessful as paralysis, writer's cramp, paraplegia 
and facial palsy, locomotor ataxia, chronic rheumatism, lumbago, 
neurasthenia, cachexia? and spinal irritation. In fact, whenever there 
is loss of power, stiffness, or pain in an accessible part, massage will 
nearly always afford relief. In chronic rheumatism, as in other af- 
fections where its employment seems advisable, a combination of 
massage with electricity will often be of benefit. In all cases the 
duration and frequency of the seances must be left to the discretion 
of the physician, and regulated by the nature of the disease. 

As to the length of time required to accomplish definite results 
with massage, Eccles* finds that in one month's massage an increase 
of strength, body-weight and appetite, with ability to sleep and work 
well, may be expected. Massage of the abdomen, according to 
Rubens-Hirschberg, f increases the quantity of the gastric juice, 
lessens dyspeptic pains, and augments the urinary flow. 

Even in health, after violent exercise, general friction of the 
body augments the vigor of the system, and consequently plays an 
important part in all methods of training. 

Under this heading mention must be made of the Weir Mitchell 
treatment of neurasthenic disorders, which, in addition to massage, 
consists of isolation, rest, over-feeding, and electricity; and also of the 

Swedish Movement cure, which is defined by Schreiber to con- 
sist " in presenting a resistance to the intended motion of the patient, 
either by the physician himself or by an assistant." 



PART III. 

PHARMACOLOGICAL REMEDIES. 

Pharmacological Remedies, or Medicines, are substances not 
essentially alimentary, which, when applied to the body, so alter or 

* The Practitioner, 1887, p. 401. 

■j- Bull. Gen. de Therap., Sept. 30th 1887, p. 241. 



PHARMACOLOGICAL REMEDIES. 53 

modify its vital functions as to be rendered applicable to the treat- 
ment of diseases. Pharmacology, accordingly, treats of the physi- 
ological action of drugs. For convenience of study the action of 
medicines is divided into local and internal : they are termed local 
when applied directly to a part (cauterants, for example) ; internal \ 
when the economy is affected, as by way of the stomach, rectum, or 
hypodermically. This division is arbitrary, since the local applica- 
tion of many substances eventually exerts an influence on the 
system. 

The designation Materia Medica is, strictly speaking, limited 
to the consideration of the nature and properties of the remedies 
used in medicine. Pharmacy is the department of Materia Medica 
which treats of the collection, preparation, preservation, and dispen- 
sation of medicines. 

To the student of medicine, the objects of examination in rela- 
tion to medicines are — the sources from which they are derived ; 
the mode in which they are prepared and brought to market ; their 
sensible qualities, and also their chemical composition and relations; 
their physiological effects, or the effects which they are capable of 
producing in healthy individuals ; their therapeutical effects, or those 
which they produce in morbid states of the system ; and, lastly, the 
doses, modes of administration, and preparations (extemporaneous 
and official), under which they are administered. 

To facilitate a uniform nomenclature and dispensation of medi- 
cines, authoritative works have been issued in different countries, 
termed Pharmacopoeias. The Pharmacopoeia of the United States 
was first promulgated by the authority of a convention held at Wash- 
ington, in 1820, and it has since been revised decennially. It fur- 
nishes a list of articles which are in general use, describes tests for 
their purity where required, sets forth the weights and measures 
which are employed in dispensing and preparing them, and supplies 
formulae for such preparations as should be kept in the shops, and 
which are thence termed official, from the Latin word officium, 
authority. " All the articles are arranged in a continuous alphabetical 
order," and in no instance is the dose given. A Dispensatory differs 
from a Pharmacopoeia in containing the medical and physical history 
of the various substances with directions for dispensing the same ; 
the Pharmacopoeia is mainly restricted to the mode of preparing 
them ; it is official, while the Dispensatory is not. 

The articles considered under Materia Medica proper, or 



54 MATERIA MEDICA AND THERAPEUTICS. 

pharmacological agents, may be conveniently classified for the pur- 
pose of study under three divisions, viz. : 

1. Inorganic. 

2. Animal. 

3. Organic. 

The inorganic embraces the metallic and non-metallic bodies 
of which the iron, lead, mercurial, iodic and various other salts and 
compounds constitute familiar examples. They do not call for par- 
ticular notice here. 

From the animal kingdom are obtained a large number of 
dissimilar agents, as musk, pepsin, pancreatin, cantharides, cochineal, 
spermaceti, wax, isinglass, besides such fatty bodies as suet, lard, 
lanolin, and cod-oil, all of which are duly described in their respec- 
tive chapters. 

The organic comprises the vegetable agents. In these are found 
various proximate principles upon the presence of one or more of 
which the activity. of the plant depends. They are termed alka- 
loids, resins, oleo-resins, gums, gum-resins, oils fixed and volatile, 
pectin, vegetable acids, glucosides, starch, sugar, ferments, bitter- 
extractives, and albuminous principles. 

The alkaloids are nitrogenous bodies so called from their re- 
semblance to the alkalies, and consist of two kinds, the volatile and 
fixed. They have an alkaline reaction, a bitter taste, are insoluble 
in water, but mix readily with alcohol, are for the most part crystal- 
line, and possess in a marked degree a similarity in structure to the 
compound ammonias. Their construction is not yet known, but there 
is good evidence for the belief that they are derivatives of single, 
double, etc., molecules of ammonia. Most alkaloids are precipitated 
from solution by tannic acid, and the iodides and bromides, which 
form with them salts of the alkaloids. Various artificial alkaloids 
have been formed to which the name amines is applied, trimetliyla- 
mine being an example. The only volatile alkaloids in the Materia 
Medica are conine and nicotine. 

The resins are non-volatile, brittle, solid bodies, found generally 
associated with the volatile oils in plant-life, and are thought to be 
mixtures of weak acids. By the oxidation of the volatile oil, or 
by distilling it, the resin is obtained. Resins are freely soluble in 
alcohol forming varnish. Oleo-resins are mixtures of a resin and 



PHARMACOLOGICAL REMEDIES. 55 

a volatile oil. Resins that yield cinnamic or benzoic acids are 
termed balsams. 

The gums are amorphous exudations from the stems of various 
plants, insoluble in alcohol, and which with water swell up to form 
mucilage. They are composed of two hydrocarbons, arabin and 
bassorin, which exist united as acids to magnesium, potassium, or 
calcium. Gum-resins are likewise plant-exudations and consist of 
gums, resins, and volatile oils in various proportions. 

The fixed oils as castor, olive, etc., are chemical compounds of 
stearic, palmitic and oleic acids, united to the base glyceryl. They 
are obtained by expression. In the process of saponification the 
base is liberated as glycerin, the acidulous radical forming with 
the alkali, soap. 

Volatile oils are mostly obtained by distillation from the flowers, 
fruit, seed, etc., and retain the odor of the plant whence they are 
derived. They possess a highly aromatic smell. They usually 
consist of liquid hydrocarbons mixed with solid oxidized hydro- 
carbons. Many of them are isomers of the oil of turpentine, and are 
hence called terpenes. When the liquid hydrocarbon is driven off 
by distillation resin is left behind. 

Pectin is a peculiar body which imparts to plant-juices the 
property of gelatinization. It forms a large portion of Irish 
moss. 

The usual vegetable acids are citric, tartaric, acetic and tannic, 
though many others are obtained from the vegetable Materia 
Medica. Citric and tartaric exist naturally in the juices of the fruits 
of various plants. Acetic, though found in minute proportion in 
nature, is an artificial product obtained by the destructive distillation 
of wood, or by the oxidation of ethylic alcohol in the presence of a 
nitrogenous ferment. Tannic acid, the astringent principle of galls, 
oak-bark, etc., is widely diffused throughout the vegetable kingdom 
and is obtained from galls by the agency of washed ether. The 
vegetable acids unite to form definite compounds with various bases. 
Tannic acid, though a glucoside, precipitates those bodies as well 
as the alkaloids, and forms with ferric salts, ink. 

The glucosides are vegetable substances composed of carbon, 
hydrogen and oxygen, which may be resolved by the aid of ebulli- 
tion, acids, alkalies or ferments into sugar by taking up the elements 
of water, at the same time a second body is formed which differs 
according to the substance acted on. Salicin and tannin are familiar 



56 MATERIA MEDICA AND THERAPEUTICS. 

examples of glucosides. Such neutral principles as elaterin and 
picrotoxin are classed with the glucosides, though of uncertain 
nature. 

The remaining vegetable proximate principles do not call for 
special mention here. The ferments emulsin and amygdalin are 
noticed under oil of almonds and mustard ; sugar and starch with 
demulcents ; bitter-extractive with tonics. 

MODUS OPERANDI OF MEDICINES. 

The medium through which the influence of medicines is exerted 
on remote parts of the body, or their modus operandi (as it is usually 
termed), was long a contested point, but it is now generally admitted 
that the absorption or passage of the medicinal or poisonous mole- 
cules into the blood is necessary to their action on parts remote from 
the seat of impression. It was Magendie who first conclusively 
demonstrated that poisons act on the spinal cord through the circu- 
lation, and not by means of the lymph and nerves. 

While, however, it is well established that the characteristic 
action of medicines is transmitted to the parts influenced, exclusively 
through the medium of the circulation, it is undeniable that the 
functions of the nervous system may be secondarily excited by a 
local medicinal impression. The number of agents which operate 
in this manner is, however, very limited. 

The action of medicines by absorption is proved by a variety 
of facts. 

They are detected in many parts of the system remote from 
that to which they have been applied, having been found in the 
blood, the solids, and the excretions, after being taken into the 
stomach. If the circulation be interrupted, the influence of a poison 
cannot be transmitted ; while its effects have been obtained, when 
applied to a wound in the foot of an animal, after all parts of the 
extremity have been severed except the artery and vein. In con- 
firmation of the doctrine of absorption may be cited also the admitted 
facts, that the remote effects of medicines or poisons are promoted 
or retarded by circumstances which promote or retard absorption ; 
that the blood of poisoned animals is found to possess poisonous 
properties ; that the fluids and solids acquire medicinal properties 
after the use of medicines (as the milk of nurses) ; that the specific 
effects of medicines are produced by their injection into the blood; 



PHARMACOLOGICAL REMEDIES. 57 

and that medicines disappear from closed cavities into which they 
are introduced. 

After their absorption into the blood, medicines circulate with 
it, penetrate through the capillaries to the various organs, and are 
afterward thrown out of the system with the excretions. Some 
medicines produce changes in the condition of the circulating 
fluid. Others have a specific action upon some one or other of 
the organs of the body. And, in passing out of the system, most 
medicines act as excitants of the organs by which they are thrown 
out. 

The absorption of medicines is effected principally by the capil- 
laries, and in some degree also by the lymphatics and lacteals. The 
medicinal particles penetrate or soak through the interstices of the 
tissue with which they are placed in contact, and are thence diffused 
through the circulation. To a limited extent, medicinal substances 
probably penetrate all the tissues of the part to which they are 
applied, and in this way the activity of medicines is most decided 
upon the organs contiguous to the seat of application. 

The absorption of insoluble substances cannot take place until 
they are previously rendered soluble. In the stomach, this is 
accomplished partly by the agency of the acids of digestion and 
partly by the albuminoid constituents of the gastric fluid. Some 
substances are dissolved by the alkaline liquids of the small in- 
testine. 

It is objected to the theory of the operation of medicines by 
absorption, that certain poisons act with a rapidity incompatible with 
their previous introduction into the circulation. This is, however, 
not the fact, as the action of the most violent poisons (hydrocyanic 
acid, for example) is never wholly instantaneous ; and careful experi- 
ments have shown that the velocity of the circulation is sufficient to 
diffuse a poison through the blood in a shorter space of time than 
its effects are ever observed on the system. 

CIRCUMSTANCES WHICH MODIFY THE EFFECTS OF MEDICINES. 

The circumstances which modify the effects of medicines relate 
both to the medicines and to the human system. 

I. The properties of medicines are modified by the soil in which 
they grow, by climate, cultivation, age, and the season of the year 
at which they are gathered. 



58 MATERIA MEDICA AND THERAPEUTICS. 

2. Medicines are more active, because more readily absorbed, 
in a state of solution than in a solid state. 

3. Soluble medicines are often rendered inert by a chemical 
reaction which converts them into insolubles, or by a physiological 
antagonism, exerted by some other medicine taken at or about the 
same time, which counteracts their effects throughout a part or the 
whole of their range of action ; in this way chemical and physio- 
logical antidotes modify the effects of poisons. When the chemical 
composition of medicines involves their mutual decomposition, they 
are said to be incompatible. 

4. Differences in dose greatly modify the effects of medicines. 

5. Pharmaceutical modifications have an important influence on 
the efficacy of medicines. They may be exhibited in the solid, semi- 
solid, liquid and aeriform states. 

In the solid state they are administered in the shape of abstracts, 
triturations, powders, pills, lozenges, confections and papers. 

In the liquid state they are administered in the shape of mix- 
tures, solutions, medicated waters, infusions, decoctions, tinctures, 
spirits, wines, juices, vinegars, honeys, syrups, fluid extracts, glycer- 
ites and oleo-resins. 

In the semi-solid or soft state they are employed internally, in 
the form of suppositories and extracts ; and externally in that of 
liniments, ointments, cerates, oleates, plasters and cataplasms. 

In the form of gases and vapors, medicines are used for purposes 
of inhalation. 

SOLIDS. 

Abstracts (Abstracta) are solid preparations in the form of 
powder. They are twice as strong as the drug or the fluid extract, 
and are about ten times as strong as the tincture, and are alcoholic 
extracts, diluted with sugar of milk. 

Triturations (Triturationes) are prepared by thoroughly tritu- 
rating in a mortar, 10 parts of the medicinal substance with 90 
parts of sugar of milk (which should be gradually added, and the 
process continued until the whole is thoroughly mixed and finely 
powdered). 

Powders (Pulveres). The form of powder is usually selected 
for the administration of medicines which are not bulky, nor of dis- 
agreeable taste, have no corrosive property, nor deliquesce rapidly 
on exposure. Deliquescent substances, and such as contain a large 
proportion of fixed or volatile oil, should always be recently pul- 



PHARMACOLOGICAL REMEDIES. 59 

verized, as they deteriorate when kept. Most substances employed 
in the form of powder are usually pulverized on a large scale. For 
the purpose of pulverizing drugs in small quantity, the physician 
makes use of a pcst/e and mortar, the finer particles being afterward 
separated from the coarser by a sieve. In some cases, a stone-slab 
and muller are used. Some powders are obtained by precipitation ; 
and the finer particles of a powder are often separated from the 
coarser by a process termed elutriation, in which the powder is dif- 
fused through water, the heavier portions being first allowed to sub- 
side, and the liquid being poured off, the finer particles settle sep- 
arately. Volatile substances are often finely powdered by sublimation 
and by suddenly condensing their vapors. 

Salts of difficult pulverization are often granulated, by making 
a hot saturated solution of the salt, and filtering and stirring the 
filtered liquid until cool. Of late years granulated effervescing salts 
have been used in imitation of the waters of mineral springs, the 
effervescence being produced by the addition of sodium bicarbonate 
and tartaric or citric acid. 

Pills (Pilidce) are small globular masses, of a semi-solid con- 
sistence, and of a size that can be conveniently swallowed. 

The form of pill is suitable for the exhibition of medicines 
which are not bulky, and are of disagreeable taste or smell, or in- 
soluble in water. Deliquescent substances should not be made into 
pills, and those which are efflorescent should be previously deprived 
of their water of crystallization. 

Some substances are readily made into pills with the addition 
of a little water, spirit, glycerin, extract of gentian, or syrup. Very 
soft or liquid substances require the addition of some dry inert 
powder, as acacia, to reduce them to a proper consistence. Wax 
is a good excipient for oils. 

Heavy powders are mixed with some soft solid, as confection 
of rose, plasma, manna, etc., or with a tenacious liquid, as treacle 
or syrup. When the pilular mass is properly prepared, it is rolled 
with a spatula into a cylinder of uniform thickness, and is then 
divided into the required number of pills, with the spatula, or, more 
accurately, with a pill-tile, or with a pill-machine. The pills are 
rolled into spherical form between the fingers ; and, to prevent ad- 
hesion, are dusted with some dry powder, as powdered liquorice-root, 
lycopodium, orris-root, starch, or magnesium carbonate. They 
should weigh from one to four grains, unless metallic, when a 



60 MATERIA MEDICA AND THERAPEUTICS. 

weight of from six to eight grains is admissible ; a large pill is 
termed a bolus. When long kept, pills may pass unchanged through 
the stomach and bowels, and are, therefore, objectionable. To con- 
ceal the taste and smell of pills, they are sometimes coated with gela- 
tin, collodion, mucilage, sugar, etc. When they are designed to be 
of slow operation, the modern practice of sugar coating pills answers 
very well. But, when they are intended to act quickly, the coating 
is objectionable, as it retards the solution of the pills in the gastric 
fluid. Compressed pills are made without excipients, simply by sub- 
jecting medicinal substances to pressure in moulds ; in this way, ex- 
traneous matter is avoided, and smaller bulk is secured. Gelatin- 
capsules are used to enclose disagreeable medicaments. 

Troches or Lozenges (Trockisci) are small, dry, solid masses, 
made of powders with sugar and mucilage, and intended to be held 
in the mouth and allowed to dissolve slowly. Mucilage of traga- 
canth is usually employed in preparing lozenges. 

Confections (Confectiones) are soft, solid preparations, made 
with some saccharine matter. They are, subdivided into Conserves 
and Electuaries : the former consist of combinations of recent vege- 
table substances and refined sugar, beat into a uniform mass ; the 
latter are extemporaneous mixtures of medicines, usually dry pow- 
ders, with syrup, honey or treacle. 

Papers [Chartce) are preparations designed for external applica- 
tion, which are made by spreading mixtures of medicinal substances, 
as cantharides or mustard, upon paper. 

LIQUIDS. 

Mixtures (Misturce) are preparations of insoluble substances 
suspended in water by means of acacia, sugar, the yolk of eggs, or 
other viscid matter. When the suspended substance is oleaginous 
the mixture is termed an emulsion. 

Solutions [Liquor es) are solutions (chiefly aqueous) of non- 
volatile substances, which are wholly soluble in the menstruum 
employed. In making solutions, and all other aqueous preparations, 
the water used should be fresh river, rain, or distilled water, and 
free from saline impurities. 

Medicated Waters (Ague?) are preparations consisting of water 
holding volatile or gaseous substances in solution. They are 
best made by distilling water from plants containing volatile oils, 
and are thence termed distilled waters. In place of distillation, 



PHARMACOLOGICAL REMEDIES. 61 

trituration with magnesium carbonate (afterwards separated by fil- 
tration) is often employed to impregnate water with volatile oils ; 
but the watery distillates have a more delicate fragrance and flavor. 
Infusions (Infnsa) * are partial solutions of vegetable substances 
in water, obtained without the aid of ebullition. They are made 
with both hot and cold water ; the former extracts the soluble prin- 
ciples more rapidly and in larger proportion ; the latter is preferred 
should the active principles be injurable by heat, or if it be desirable 
not to take up some matter insoluble at a low temperature. When 
the process takes place at a heat of from 6o° to 90 it is termed 
maceration ; when at a heat of from 90 to ioo°, digestion. A more 
efficient mode of extracting the medicinal virtues of plants is perco- 
lation or displacement. In this operation, the medicinal substance is 
coarsely powdered and placed in a conical or nearly cylindrical in- 
strument called a percolator, in the lower part of which is fitted a 
porous or colander-like partition or diaphragm. The powder is then 
saturated with water or other menstruum till it will absorb no more ; 
and, after they have remained for some time in contact, fresh por- 
tions of the menstruum are added, till the required quantity is em- 
ployed. The fresh liquid, as it is successively added, percolates the 
solid particles of the medicinal substance, driving the previously 
saturated liquid before it ; and in this way completely exhausts the 
substance to be dissolved. An ordinary glass funnel answers very 
well for percolation ; and a circular piece of muslin or lint, pressed 
into the neck by means of a cork with notched sides, forms a good 
diaphragm — care being taken to interpose a similar piece of muslin, 
moistened slightly with the menstruum, between the diaphragm and 
powder. 



*" An ordinary Infusion, the strength of which is not directed by the physician, nor spe- 
cified by the Pharmacopoeia, shall be prepared by the following formula : — 

Take of 

The Substance, coarsely comminuted, ten parts 10 

Boiling Water, one hundred parts 100 

Water, a sufficient quantity 

To make one hundred parts 100 

Put the Substance into a suitable vessel, provided with a cover, pour upon it the Boiling 
Water, cover the vessel tightly, and let it stand two hours. Then strain, and pass enough 
Water through the strainer to make the Infusion weigh one hundred (100) parts." — (U. S. 
P., 1880.) 



62 MATERIA MEDIC A AND THERAPEUTICS. 

Decoctions (Decocta) * are partial solutions of vegetable sub- 
stances in water, in which the active principles are obtained by- 
ebullition. This is a more rapid and efficient mode of extracting 
the virtues of plants than by infusion. But it is objectionable when 
the proximate principles are volatile at a boiling heat or undergo 
decomposition by ebullition. In making decoctions ebullition 
should be continued for a few minutes only, and the liquid should 
be allowed to cool slowly in a close vessel. As they are apt to 
spoil, they should be prepared only when wanted for use. 

Tinctures (Tinctures) are solutions of medicinal substances in 
alcohol or diluted alcohol. The aromatic spirit of ammonia and 
ethereal spirit are also sometimes employed as solvents ;* and solu- 
tions in these menstrua are called ammoniated tinctures and ethereal 
tinctures. Alcohol or rectified spirits (sp. gr. 0.820, U. S. P.) is em- 
ployed in making tinctures of substances nearly or quite insoluble 
in water, as the resins, iodine, etc. Diluted alcohol or proof-spirit 
(equal weights of official alcohol and water) is preferred, when the 
substance is soluble both in alcohol and, water, or when some of its 
ingredients are soluble in the one menstruum and some in the other. 
Tinctures have been usually prepared by maceration or digestion, 
more commonly by the former process, and a period of two weeks 
is recommended for its duration. It should be conducted in well- 
closed glass-vessels, which should be frequently shaken ; and when 
the maceration is completed, the tincture should be separated from 
the dregs by filtration. The U. S. P. now recommends percolation 
in making most tinctures, and, in the hands of skilful pharmaceutists, 
this process is preferable, as the most thorough mode of exhausting 
medicinal substances ; but, where the operator cannot trust himself, 
it is better to recur to the old process of maceration. Tinctures 
should be kept in bottles accurately stoppered to prevent evapora- 
tion, which might seriously increase their strength. 

* " An ordinary Decoction, the strength of which is not directed by the physician, nor 
specified by the Pharmacopoeia, shall be prepared by the following formula : — 
Take of 

The Substance, coarsely comminuted, ten parts 10 

Water, a sufficient quantity 

To make one hundred parts ioo 

Put the Substance into a suitable vessel, provided with a cover, pour upon it one hundred 
(100) parts of Cold Water, cover it well, and boil for fifteen minutes ; then let it cool to about 
45 C. (113 F.). Strain the liquid, and pass through the strainer enough cold water to 
make the product weigh one hundred (ioo) parts." — (U. S. P., 1880.) 



PHARMACOLOGICAL REMEDIES. 63 

• 
Tinctures of Fresh Herbs (Tine tune Herbarnm Recentium). 

" These tinctures, when not otherwise directed, are to be prepared 

by the following formula: — 

Take of 

The Fresh Herb, bruised or crushed, fijty parts 50 

Alcohol, one hundred parts 100 

Macerate the herb with the alcohol for fourteen days ; then express 
the liquid and filter." (U. S. P., 1880.) 

The form of tincture is adapted to the exhibition of medicines 
which are to be given in small quantity, and it affords a convenient 
mode of graduating doses. In prescribing large and continued 
doses of tinctures, the stimulating effects of the alcohol which they 
contain must be borne in mind. 

Spirits (Spiritus) are alcoholic solutions of volatile or gaseous 
principles, properly speaking procured by distillation, but now usu- 
ally prepared by dissolving the volatile principles in alcohol or 
diluted alcohol. The spirits of the aromatic vegetable oils are used 
to give a pleasant odor and taste to mixtures, to correct the nause- 
ating and griping effects of cathartics, and also as carminatives and 
stomachics. 

Wines (Vina) are solutions of medicinal substances in stronger 
white wines. 

Vinegars (Acetd) are infusions or solutions of medicinal sub- 
stances in distilled vinegar or diluted acetic acid. 

Honeys (Mellita) are preparations of medicinal substances in 
honey. 

Syrups (Syrupt) are preparations of medicinal substances in 
concentrated solutions of sugar. The term syrup (syrupus), or 
simple syrup, is applied to a solution of sugar (65 parts) in water 
(sufficient to make 100 parts of syrup), dissolved with the aid of 
heat. Medicated syrups are usually made by incorporating refined 
sugar with vegetable infusions, decoctions, expressed juices, fer- 
mented liquors, or simple aqueous solutions. They may also be 
prepared by adding a tincture to simple syrup, and afterward evapo- 
rating the alcohol ; or by mixing the tincture with sugar in coarse 
powder, and dissolving the impregnated sugar, after evaporation, in 
the necessary proportion of water. Syrups are apt to be spoiled by 
heat, and should be made in small quantities at a time. 

Fluid Extracts (Extracta Fluidd) have the advantage over 



64 MATERIA MEDIC A AND THERAPEUTICS. 

solid extracts of convenience of administration, and of being pre- 
pared at a less degree of heat. In preparing them alcohol and 
glycerin are the menstrua chiefly resorted to. The portion of the 
solvent which remains after evaporation contributes in some degree 
to the preservation of the preparation. According to the U. S. P., 
1880, 1 c.c. of the fluid extract represents 1 gm. of the drug — a 
decrease in strength of about 5 per cent, from the former standard. 

Glycerites {Glycerita) are solutions of medicinal substances 
in glycerin, made by rubbing them together in a mortar. 

The Oleo-Resins (Oleo-resince) are extracts obtained by the 
agency of ether, which consists of fixed or volatile oils, holding 
resins, and sometimes other active matters in solution. They 
retain a liquid or semi-liquid state upon the evaporation of the 
menstruum employed in their preparation, and have the property of 
self-preservation. 

SEMI-SOLIDS. 

Suppositories (Suppositoria) are soft solids, made by the mixture 
of a medicinal substance with the oil, of theobroma, usually in a 
conical form, of a weight of 1 5 grains, and designed for introduc- 
tion into the rectum. They are employed with a view both to a 
local effect on the lower bowel and also to the gradual absorption of 
the medicinal substance. As absorption from the rectum is slow, 
larger quantities are required than by the mouth. 

'Extracts (Extracta). — By the evaporation of the solutions of 
vegetable principles, a very useful class of preparations, termed Ex- 
tracts, is obtained. They are prepared from infusions, decoctions, 
tinctures and vinegars, and sometimes, in the case of recent vege- 
tables, from the expressed juices of plants, usually diluted with 
waten Extracts prepared by the agency of water are termed watery 
extracts ; those by means of alcohol, alcoholic extracts ; those by 
means of acetic acid, acetic extracts. The evaporation of extracts is 
generally continued till they have a pilular consistence. 

Liniments (Linimenta) are oily preparations designed for ex- 
ternal use, usually thicker than water, but always liquid at the 
temperature of the body. 

Ointments (Unguentd) are preparations of a consistence like 
that of butter, made with lard or some other fatty substance. They 
are fitted for application to the skin by friction or inunction. Most 
of the ointments become rancid when long kept, and it is therefore 
best to prepare them only as wanted for use. The term ointment 



PHARMACOLOGICAL REMEDIES. 05 

(iinguentuiri) is applied to a mixture of 20 parts of yellow wax and 
80 parts of lard. Petrolatum, a substitute for vaseiine, a straw- 
colored ointment made from petroleum, not decomposable, is a 
superior unguent for general purposes (see petrolatum). 

Cerates (Cerata) are made of oil or lard, mixed with wax, 
spermaceti or resin, with the addition of various medicinal substances. 
They are of harder consistence than ointments, and do not melt 
when applied to the skin. The term cerate (ceratum) is applied to a 
mixture of 30 parts of white wax and 70 parts of lard. 

Oleates (Oleata) are made by combining oleic acid with 
metallic bases or alkaloids. The combination is effected by rubbing 
them together in a mortar, and is generally aided by heat. 

Plasters (Emplastra) are adhesive at the temperature of the 
body, and must generally be heated to be spread. Some substances 
have sufficient consistence and adhesiveness to be made into pias- 
ters. Usually, however, medicinal substances, when employed in 
this form, are mixed with Lead-Plaster or Litharge Plaster {Emplas- 
trum Plumbi), a compound of olive-oil and litharge. Plasters are 
prepared for use by spreading them upon sheepskin, linen or muslin, 
with a margin a quarter or half-inch broad. 

Cataplasms or Poultices {Cataplasmatd) are soft, moist sub- 
stances intended for external use. The common emollient poultice, 
employed to relieve inflammation and to promote suppuration, is 
made by mixing bread-crumbs with boiling milk or powdered flax- 
seed with boiling water (see poultices). A fabric termed spongiopi- 
line y consisting principally of sponge, has been used as a substitute 
for the old .poultice, and, when saturated with hot water, is a good 
vehicle of heat and moisture. 

GASES AND VAPORS. 

When employed in this form medicines are administered by 
inhalation. This may be effected either by diffusing the gas or 
vapor through the air to be respired by the patient; or by inclosing 
it in a bag or bottle with a suitable tube, through which the patient 
may breathe; or, when ethereal vapors are employed, by saturating 
a sponge or handkerchief with the ether and applying it to the 
mouth and nostrils of the patient; or the fumes of burning medicinal 
substances may be inhaled by means of cigarettes or pipes variously 
contrived. 



66 MATERIA MEDICA AND THERAPEUTICS. 

WEIGHTS AND MEASURES 

In prescribing and dispensing medicines the following are the 
iveights and measures employed in the United States, with their signs 
annexed :— 



TROY OR APOTHECARIES' WEIGHT. 

The pound, ib 

contains 



Twelve ounces, ^ . 
Eight drachms, 3 . 
Three scruples, ^ • 
Twenty grains, gr. 



The ounce 

The drachm 

The scruple 

The term pound should be avoided in formulae, owing to the 
danger of mistakes from confounding the Troy pound with the 
heavier avoirdupois pound, and large weights should be expressed 
in Troy ounces. The scruple sign (3) should not be used in pre- 
scribing, because of the liability of mistaking it for the drachm (5). 
All weights of less than a drachm should be expressed in grains 
(gr.). The Troy ounce contains 480 grains; the drachm, 60 grains. 

In France and other parts of the continent of Europe a system 
of metrical weights is employed, having for its unit the meter (39.37 
inches), which is the ten-millionth part of the distance from the pole 
to the equator measured on any meridian. From this basis all other 
weights and measures are calculated. As all the divisions are ob- 
tained from the multiple ten, it is purely a decimal system. The 
names given to the different multiples and divisions of the unit are 
indicated by prefixes derived from the Latin and Greek. 

FOR SUBDIVISION. 

C Milli indicates the 
Deci 



Latin -s Centi " " yi^ 



TO 
FOR MULTIPLICATION. 



Greek 



Deca indicates 10 times the unit. 

Hecto " 100 " " 

Kilo " 1,000 " " 

Myria " 10,000 " " 



In the metric system, fluids as well as solids are expressed by 
weight, consequently the gram (unit of weight) and its decimal di- 
visions enter only into the calculation of a prescription. A gram 
is the weight of a cubic centimeter of water at 4 C. The subdi- 
visions of the gram are milligram, centigram and decigram ; the 
multiplications , decagram, hectogram, etc. Instead of using the 



PI LI RMA COL OGICAL REMEDIES. 



<>7 



latter terms the total is better expressed in grams. The sign Gm. 
is used to denote gram; c. c, cubic centimeter, and to denote quan- 
tity, Arabic figures; the latter should precede the symbol. In pre- 
scribing liquids, allowance must be made for the relation existing 
between sp. gr. and bulk. In each case, of spirits, tinctures and 
oils -^ less, of stronger ether \ less, of spirit of nitrous ether ^ less, 
of glycerin J more, of syrup \ more, of chloroform J more, must be 
ordered. In the case of spirits and tinctures the difference being 
slight it may be disregarded. Rules for expressing quantity 
by weight of the Troy system in metric terms : A. Reduce the 
quantity to grains and divide by 15; the quotient expresses the 
quantity in grams (nearly). B. Reduce each quantity to drachms 
and multiply the number by 4; the product is the number of grams 
representing nearly the same quantity. These rules are to be em- 
ployed in changing fluid measures to grams. In round numbers 
if§ = 30 c. c,; 1 c. c. or Gm. = gr. 15 J^of distilled water at 4 C. 
It has been suggested to use the term flui-gram for c. c. (Mann and 
Oldberg.) 



Comparative Table of Decimal with Troy Weights. 


Names. 


Equivalent in Grams. 


Equivalent in Grains. 


Equivalent in Troy Weight. 


Milligram . . . 
Centigram . . . 
Decigram . . . 

Gram 

Decagram . . . 
Hectogram . . 
Kilogram . . . 
Myriagram . . 


.OOI 
.OI 

I 

IO 

IOO 

IOOO 

I OOOO 


•OI54 
•1543 

1-5434 

154340 

I54-3402 

I543-4023 

15434-0234 

154340.2344 


64 

1 

s 

i-5 

15 4 

2 340 

3 1 43-o 
2 8 1 14. 
26 9 4 20. 



The gallon, C. 
The pint 
The fluidounce 
The fluidrachm 



WINE OR APOTHECARIES' MEASURE. 



contains 



Eight pints, O. 
Sixteen fluidounces, f ^ 
Eight fluidrachms, f 3 . 
Sixty minims, TTL- 



The term gallon is not used by the U. S. Pharmacopoeia, that 
measure being always expressed in pints. 

Liquid measures are sometimes prescribed by drops, which, 
however, vary in quantity according to the nature of the liquid, the 
shape and size of the vessel from which they are dropped, and even 



6S 



MATERIA MEDICA AND THERAPEUTICS. 



the amount of liquid which the vessel contains. (Thus, a fluidrachm 
of distilled water contains only 45 drops, while this measure of al- 
cohol and of most tinctures contains 120 drops, and of chloroform 
220 drops, or even more.) Approximate measurements are also 
frequently employed in prescribing the less powerful liquids : thus 
a teacup is used for fSiv, or a gill ; a wineglass for f oij ; a tablespoon 
for f§ss ; a teaspoon for f5j ; as these are uncertain, a graduated 
measure is preferable. 



Table for Conva 


'ting Cubic Centimeters 


into 


Fluidrachms. 




Cubic Centimeters. 


0. 1. 


2. 


3. 


4. 


5. 


6. 


7.. 


8. 


9. 




dr. m. dr. m. 


dr. m. 


dr m 


dr m. 


dr. m. 


dr. m. 


dr. m. 


dr. m. 


dr m. 


O 


O O l6 


O32 


O49 


15 


I 21 


137 


L 53 


2 IO 


2 26 


IO 


242 258 


3 15 


3 31 


3 47 


43 


4 19 


4 3 6 


4 52 


58 


20 


5 24 5 41 


5 57 


6 13 


6 29 


646 


72 


718 


7 34 


7 51 


30 


87 823 


8 39 


856 


912 


928 


9 44 


IO 


10 17 


I0 33 


40 


IO49! II 5 


11 22 


II38 


11 54 


12 10 


12 27 


'1243 1259 


13 15 


50 


I33IjI348 


144 


14 20 


14 3 6 


14 53 


15 9 


15 25 15 4i 


15 58 


60 


l6 14 16 30 


1646 


172. 


1719 


17 35 J 7 5i 


187 J1824 


1840 


70 


l8 56 19 12 


1928 


I944 


20 1 


2017(2034 


20 50121 6 


21 22 


80 


213821 55 


22 11 


22 27 


2243 


23 23 16 


23322348 


24 4 


90 


24202437 


24 53 


25 9 


25 26 


25422558 


2614I2631 

1 


2647 



100 cubic centimeters are equal to 27 fluidrachms 3 minims, or 3 fluidounces 3 flui- 
drachms and 3 minims. 



A variety of circumstances, relating to the human organism, 
modify the effects of medicines. 

Age exerts a most important influence in this particular. Chil- 
dren are more susceptible than adults; and in advanced - age, also, 
smaller doses are required than in the prime of life. No general 
rule can be laid down for the adaptation of the doses of medicine to 
different ages, as the susceptibilities to the influence of different 
medicines are unequal at the same age. Thus, infants are peculiarly 
alive to impressions from opium, while in the cases of calomel and 
castor oil, they will bear much larger proportional doses. 

Dr. Young's scheme for graduating the doses of medicines to 
different ages answers very well in prescribing : For children under 
twelve years, the doses of most medicines must be diminished in 
the proportion of the age to the age increased by 12; thus, at two 
years to \, viz.: ~^ = \. At 21 the full dose may be given. 



PHARMACOLOGICAL REMEDIES. 



69 



Afaifc/i's Table for Converting Apothecaries^ 
into Gram Weights. 



Weights and Measures 











Grams for Liql 


IDS. 




Troy Weight. 


Grams. 


Apothecaries' 
Measures. 






















Lighter 


Spec. Grav. 


Heavier 










than Water. 


of Water. 


than Water. 


( 


.rain T * ff 


.004 


• 
Minim 1 


.055 


.06 


.08 




1 


•005 


2 


.IO 


.12 


•15 




lo 


.006 


3 


.16 


.18 


•24 




t 


.008 


4 


.22 


•24 


•32 




* 


.OIO 


5 


.28 


•3 


.40 




\ 


.Ol6 


6 


.32 


.36 


.48 




i 


.02 


7 


.38 


•42 


•55 




i 


•03 


8 


•45 


•5 


.65 




1 


.05 


9 


•50 


•55 


•73 






.07 


10 


•55 


.b 


.80 




2 


•13 


12 


. -65 


.72 


.96 




3 


.20 


14 


.76 


.85 


1. 12 




4 


.26 


15 


.80 


-9 


1.20 




5 


•32 


16 


.90 


1.0 


1-32 




6 


•39 


20 


1.12 


1.25 


1.60 




7 


•45 


25 


I.40 


1-55 


2.00 




8 


•52 


30 


I.70 


1.90 


2.50 




9 


•59 


35 


2.00 


2.20 


2.90 




io(9ss) 


.65 


40 


2.25 


2.50 


3-3° 




12 


.78 


48 


2.70 


3-0 


4.00 




H 


.90 


5o 


2.8o 


3.12 


4.15 




15 


I. OO : 


60 (f 3 j) 


340 


3-75 


5.00 




16 


I.05 


65 


3.60 


4.0 


5-30 




18 


I. 18 


72 


4 05 


4-5 


6.00 




20(BJ) 


i-3 


80 


4.50 


5o 


6.65 




24 


i-5 


90(13155) 


5-IO 


5-6 


7-5° 




3o(H ss ) 


1-95 


96 


5-40 


6.0 


800 




32 


2.1 


IOO 


5.60 


6.25 


8.30 




36 


2.2 


I20(f^ij) 


6.75 


7-5 


10.00 




4o(9ij) 


2.6 


150 (f^iiss) 


8.50 


9-5 


12.50 




45 


3-o 


160 


9.OO 


1 0.0 


i3-3o 




50 ( £)nss) 


3-2 


180 (f^iij) 


IO.IO 


n. 25 


15.00 




60 (3J) 


3-9 


210 (f^iiiss) 


II.80 


13.0 


17.50 




70 


4-55 


240 (13 iv) 


I3-50 


15.0 


20.00 




8o(9iv) 


5-2 


f 3 v 


16.90 


18.75 


25.00 




90 (^iss) 


5-9 


f^vss 


18.60 


20.75 


27.50 




100 (JJv) 


6-5 


f 3 v J 


20.25 


225 


3000 




noOvss) 


71 


f3 vi J „ N 


23.60 


26.25 


35-00 




120 (gij) 


7.80 


i -f^viij (f^j) 


27.OO 


30.0 


40.00 




150 (giiss) 


9-75 


f^ix 


30.40 


33-75 


45.00 




i8o(ziij) 


11.65 


f 3 x .. _ x 


33-75 


37-5 ■ 


50.00 




240 (|ss) 


15-5 


f 3 xl J ( f 3 lss ) 


4O.5O 


45-o 


60.00 , 




300 ( 3 V) 


19.4 


f zxiv 


47.25 


52.5 


70.00 




360 (3vj) 


23.3 


f|ij 


54.OO 


60.0 


80.00 




4 20(Zvij) 


27.2 


f 3 iiss 


67.50 


75-o 


100.00 




480 (lj) 


31 .1 


ffiij 


8l.OO 


90.0 


120.00 




3*1 


62.2 


f 5 iiiss 


94.50 


105.0 


140.00 




5 iv 


124.4 


f'Jiv 


I08.00 


1200 


160.00 



70 MATERIA MEDICA AND THERAPEUTICS. 

A good practical rule for graduating doses is that of Dr. Cow- 
ling : "The proportional dose for any age under adult life is rep- 
resented by the number of the following birthday divided by twenty- 
four ; " for one year -h — tz ; for three years, A = i ; for eleven 
years, if = \ . 

Sex, temperament, and idiosyncrasy, all modify the effects of 
medicines. Women require somewhat smaller doses than men ; 
and during menstruation, pregnancy, and lactation, all active treat- 
ment which is not imperatively demanded should be avoided. To 
persons of a sanguine temperament, stimulants are to be administered 
with caution, while, in cases of the nervous temperament, the same 
care is to be observed in the employment of evacuants. Mercurials 
are called for where the bilious temperament exists, but, on the 
other hand, they are generally injurious where the lymphatic tem- 
perament is strongly marked. Idiosyncrasy renders many individuals 
peculiarly susceptible or insusceptible to the action of particular 
medicines, as mercury, opium, etc. 

In disease, an extraordinary tolerance of the action of many 
medicines is established. In tetanus, immense quantities of opium 
are borne and required ; in typhoid fever, alcohol is freely adminis- 
tered without inducing intoxication ; in pneumonia, tartar emetic 
may be taken in large doses without nausea. 

The time of administration modifies the action of medicines. 
Where a rapid effect is desired, they are to be given on an empty 
stomach ; on the other hand, irritant substances, as the arsenical or 
iodic preparations, are best borne when the stomach is full ; and the 
insoluble chalybeates, requiring the gastric fluid to dissolve them, 
should be taken with the food. To counteract the collapse of low 
fevers, stimulants, in the early morning hours, are called for. 

The condition of the stomach is to be considered in prescribing 
medicines. In the black vomit of yellow fever absorption cannot 
take place by the stomach, and in the second stage of cholera endos- 
mosis by the bowels is impossible ; here the hypodermic medication 
is invaluable. 

Habit diminishes the influence of many medicines, especially 
narcotics. 

The influence of race, climate, occupation, and the imagina- 
tion, upon the effects of medicines is often decided, and deserves at- 
tention in prescribing. 



PHARMACOLOGICAL REMEDIES. 71 

PARTS TO WHICH MEDICINES ARE APPLIED. 

Medicines are applied to the Skin, to Mucous Membranes, to 
Serous Membranes, to Wounds, Ulcers, Cysts, and Abscesses, and 
they are Injected'into the Veins. 

l. To the Skin. — Medicines are applied to the skin for both a 
local and a general effect ; when brought into contact with the skin 
without friction it is termed the enepidermic method. As their in- 
fluence on distant organs is the result of their absorption, this func- 
tion must be taken into consideration. Solutions of medicinal sub- 
stances in water permeate slowly through the skin to enter the 
vessels. M. Hebert first drew attention to the fact that the oily 
secretion of the sebaceous follicles of the skin prevented the contact 
of aqueous liquids with the cuticle, though the cuticle itself is the 
main impediment to absorption. Waller* found that chloroformic 
solutions of the alkaloids placed in contact with the skin readily 
produced their effects upon the system. He ascertained that chloro- 
form readily osmoses through the skin, carrying with it dissolved 
substances, and that the rationale of the process was not due to a 
solvent action on sebaceous matter. 

The application of medicines to the skin by friction, the epider- 
mic method, is occasionally resorted to, but its results are slow and 
uncertain. When we wish to affect the system through the agency 
of the skin, the preferable method is to apply the medicine to the 
dermis denuded of the cuticle. This is termed the endermic method, 
and the cuticle is usually removed by means of a blister. The 
medicine is applied to the denuded dermis in the form of powder, or, 
if very irritating, it may be incorporated with gelatin, lard, or cerate. 
This method is useful in cases of irritability of the stomach, of in- 
ability to swallow, or where we desire to influence the system rap- 
idly and by every possible avenue*, or where it is of importance to 
apply the medicine near the seat of the disease. The dose is to be 
two or three times the amount which is administered by the stomach. 
Inunctions of oil, when the digestive apparatus is unequal to its 
absorption, are sometimes of service in asthenic conditions. The skin 
should be washed with soap and water first. 

Another means of applying medicines through the skin is by 
injection into the subcutaneous cellular tissue, and is termed the 
hypodermic method. Medicines are injected hypodermically for 

*The Practitioner, London, 1869. vol. iii, p. 330. 



72 MATERIA MEDIC A AND THERAPEUTICS. 

both a local and a general effect. A constitutional impression can 
be produced by this means more certainly, rapidly, and efficiently 
than by the introduction of medicines into the stomach. It is par- 
ticularly adapted to the speedy relief of pain, to the treatment of 
diseases in which it is desirable to influence the system with the 
greatest possible rapidity and effect, and also to cases where the in- 
ternal administration of medicines is interfered with. The substances 
proper for hypodermic injection are those which are small in bulk 
and are of perfect solubility, such as the alkaloids. Substances of 
imperfect solubility should not be injected hypodermically, danger- 
ous results having followed therefrom, as from the use of some of 
the salts of quinine. The dose, particularly in first injections, should 
be two-thirds of the ordinary dose by the stomach, and for females 
about one-half. 

The instrument used for injection is a small syringe armed 
with a sharp tubular needle, and, for the better regulation of the 
dose, it is desirable that the syringe should be graduated. It is 
important to avoid the puncture of a vein, lest a suddenly over- 
whelming effect be produced; and, with this view, the syringe-needle 
should not be pushed too deply into the tissues, and should be 
withdrawn a little to allow a wound of a vein to close from elasticity. 
When a constitutional effect only is aimed at, non-sensitive, vascular 
parts should be selected, in order to facilitate absorption and give 
little pain, such as the waist; another good spot for injection is at 
the insertion of the deltoid muscle, or into the radial border of the 
forearm, and, where repeated operations are practiced, it is well to 
vary the point of injection. Irritating injections are best tolerated 
in the back. To preserve hypodermic solutions from the destructive 
action of a low order of vegetation (algae), cherry laurel-water or a 
weak borax solution should be used. 

2. To Mucous Membranes. — Medicines are applied to all the 
gastro-pulmonary and genito-urinaiy mucous surfaces. 

a. To the conjunctiva they are applied for local effects only, 
and are termed colly ria, or eye-washes. As a rule their strength 
should be weak when first used. 

b. To the nasal ox pituitary membrane, they are applied usually 
for local purposes; sometimes, however, to irritate and excite a dis- 
charge, when they are termed errhmes, now rarely used; sometimes, 
also, to produce sneezing, with a view to the expulsion of foreign 
bodies from the nasal cavities, when they are termed sternutatories. 



PHARMACOLOGICAL REMEDIES. 



73 



c. To the mucous membrane of the mouth and throat, medicines 
are applied almost exclusively for local purposes. When in solu- 
tion, they are termed gargarismata or gargles. Powders are intro- 
duced by insufflation, as by a scoop-insufflator. In the same way 
they are blown into the external auditory canal in the treatment of 
otorrhcea, otitis, etc. 

d. To the Eustachian tubes, liquids are applied in local affections. 

e. On the aerial or tracheobronchial membrane , medicines pro- 
duce a very decided influence, both local and general. Liquid sub- 
stances are introduced into the air passages by means of a sponge 
or syringe, in the treatment of chronic inflammations of the larynx. 
This kind of instrumentation should be preceded by spraying the 



Fig. 2. 




THE HAND-BALL ATOMIZER. 



part with cocaine. Various substances are inhaled with advantage 
in phthisis, chronic bronchitis and laryngitis, asthma, etc., while the 
most powerful effects are produced on the system by the absorption 
of ethereal vapors and gases through the pulmonary surface. 

Within the last few years, liquids have been introduced into 
the air-passages for the treatment of diseases of the respiratory 
organs, in the form of a fine spray. This mode of application, 
termed the atomization of fluids, has proved very valuable, particu- 
larly in the relief of throat affections. Various instruments have 
been resorted to in the atomization of liquids. The hand-ball 
atomizer, which is usually employed, consists of two glass-tubes, 



74 MATERIA MEDIC A AND THERAPEUTICS. 

with capillary openings, placed at right angles to each other, the 
vertical tube being dipped in a bottle containing the fluid to be 
atomized, while at the other end it is close and about opposite to 
the centre of a capillary opening in the horizontal tube. This con- 
nects with an elastic tube, intercepted by two elastic balls, one in the 
middle, the other, which is furnished with valves, at the end of the 
tube. The upper ball acts as a reservoir, into which a current of 
air is forced from the lower ball by pressure with the hand. The 
air in the vertical glass tube being rarefied, the liquid rises to the 
capillary opening, and is there pulverized by the current of air from 
the horizontal tube. In Snowden's atomizer there is but one tube 
through which the fluid is forced and broken into a fine spray at 
the tip. To Sajous' pharyngeal atomizer there is a tongue-depres- 
sor attached, so that the patient can use it without assistance. 

Irritating substances should be guardedly applied to the upper 
air-passages, particularly the larynx, and before active treatment 
is instituted the membrane should be cleansed, for which purpose 
there is nothing better than to spray the parts with Dobell's solution.* 

Other medicaments well adapted to atomization are zinc sulphate 
gr. iij-v to aq. f 5j ; tannin gr. v; borax; boracic acid; silver nitrate; 
potassium permanganate, etc. The atomizer is used also to produce 
local anaesthesia, and as a deodorizer. 

As modified by Sass, by means of differently shaped tubes, the 
spray can be readily generated within various parts of the body, as 

Fig. 3. 



SASS SPRAY TUBES. 

the back of the throat, nostrils, meatus of the ear, etc. Instead of 
air, steam has been substituted as the forcing power in the apparatus 

* R Acidi carbolici liquidi, Hl xxx 

Sodii biboratis, 

Sodii bicarbonatis, aa ....... . ^j 

Glycerini, ... ............... f 3 iiiss 

Aquae, . ad f 3 iv. M. 

Sig. — To be used in atomizer. An excellent cleansing spray in acute and chronic 
nasal catarrh ; also as a mouth- wash in fetor of breath. 



PHARMACOLOGICAL REMEDIES. 75 

known as Siegle's. In this instrument inhalation can be practiced 
without fatigue or assistance, and the warmth of the spray is also 
an advantage in many diseases of the respiratory organs. The 
volatile oils, camphor, and potassium chlorate are suitable for steam 
atomization. 

f. The gastro-intestinal mucous membrane ', of all parts of the 
body, is most employed for the exhibition of medicines. The 
stomach, from its great vascularity, its solvent secretions, and the 
numerous relations which it has with almost every part of the body, 
is the chief recipient of medicinal agents. The rectum is, however, 
also frequently employed for various purposes, as to relieve disease 
of this or of neighboring organs, to occasion revulsion, to produce 
alvine evacuations, to destroy ascarides, and when, for any reason, 
it is desirable to spare the stomach. 

It is usually recommended that the dose of medicines intro- 
duced into the rectum for constitutional effects should be two or 
three times greater than when taken into the stomach. In the case 
of active, soluble medicines, however, especially narcotics, it is most 
prudent to give the same amount by the rectum as by the mouth. 

Solid substances introduced into the rectum are termed sup- 
positories. Liquids introduced into the rectum are termed clys- 
ters, lavements, injections, and enemata. (See enemeta). Soluble 
substances, when thus applied, are usually dissolved in water; in- 
soluble substances, are suspended in some mucilaginous vehicle. 
When the enema is to be retained, it should not exceed fgiij in 
quantity. When it is introduced to act upon the bowels, its bulk 
may be from fgxij-xvj for an adult, fgyj-viij for a youth of twelve, 
f5iij-iv for a child of one to five years, and f§j for a newly born in- 
fant. Various syringes are used for the administration of enemata, 
Higginson's being among the best. Gaseous matters have also 
been thrown into the rectum, tobacco smoke, for example, to relieve 
obstruction of the bowels. As the rectum is not a digestive tube, 
when food is to be introduced by this channel, the essentials for the 
carrying on artificially of this process must be added ; viz., to beef-tea 
f5iv add hydrochloric acid TTLx, and glycerole of pepsin foij ; defib- 
rinated blood, too, as a restorative agent, has been injected into the 
rectum after uterine hemorrhage, with success (Leon).* 



* Valor Terapeutico de Los Enemas de Sangre Deofibrinata ; Gaz. Med. Cat., 1886, 
IX, 711. 



76 MATERIA MEDICA AND THERAPEUTICS. 

To the tirino-genital and vagino-uterine membranes, applications 
are made exclusively for local purposes. Within a few years intra- 
uterine medication has been a good deal employed in local affections 
of the uterus, but in the injection of fluids into the uterus there is 
danger of metro-peritonitis. 

3. To Serous Membranes. — Irritating solutions are injected 
into the cavity of the tunica vaginalis testis, in hydrocele; into the 
hernial sac, in hernia ; and even into the pleural cavity, in pleurisy, 
for the purpose of producing adhesion of the sides of the sacs. 

4. To Ulcers, Wounds, and Abscesses, medicines are applied 
chiefly for their local effects. The absorbing power of these sur- 



FlG. 4. 




faces is to be kept in mind in such applications. Cysts are some- 
times cured by injections, as of tincture of iodine into cysts of the 
thyroid gland. 

5. The Injection of Medicines into the Veins has been occa- 
sionally practiced. The operation is, however, objectionable, from 
the danger of introducing air into the circulation ; and it is seldom 
resorted to, except in the case of transfusion of blood after uterine 
or other hemorrhage, or exhausting disease. 

Transfusion will often be found an efficient remedy, although 
there is always risk of coagulation of the blood in the veins. The 
more direct and immediate the transfusion, the safer the operation, 
as by Aveling's apparatus, which consists of an India-rubber bulb, 
oblong in shape, and of sufficient size to contain two fluidrachms; 
India-rubber tubes six or seven inches in length attached to the 
extremities of the bulb ; and stop-cocks attached to the outer ex- 
tremities of the tubes. Also, two silver-tubes ; one, bevel-pointed, 
called the afferent tube (seen at A), which is to be inserted into the 



PHARMACOLOGICAL REMEDIES. 77 

vein in the arm of- the patient; the other, round-pointed, called the 
efferent tube (seen at B), which is to be inserted into the vein in the 
arm of the donor, also a pair of fine forceps and a scalpel.* 

THE CLASSIFICATION OF MEDICINES. 

In treating the articles of the Materia Medica some writers 
have classified them according to their natural properties, others 
according to their action on the human system. To the student of 
medicine a classification based upon the sensible qualities or natural 
affinities of medicines can be of little value, since it associates arti- 
cles of the most opposite remedial properties. A classification of 
medicines founded on a similarity of action on the animal economy 



* The mode of operation is as follows : — 

First, place the apparatus in a basin of tepid water, and while completely under the 
water, for the purpose of filling it and insuring its cleanliness, compress and expand the bulb 
until the air contained within the bulb and rubber-tubing is completely expelled. When the 
air has been completely expelled, and while the apparatus is yet remaining beneath the sur- 
face of the water, turn the stop-cocks at both extremities of the rubber-tubing in such a man- 
ner as to entirely preclude the possibility of air gaining access to its cavity. The patient 
having been brought to the side of the bed and the arm made bare, a fold of skin over a vein 
at the bend of the arm is to be raised, transfixed and divided. The vein now brought into 
view is to be seized with the fine forceps, slightly raised, and a small opening made into it for 
the reception of the bevel-pointed silver or afferent tube. This tube, which has been lying 
in the basin of tepid water, should carefully be kept filled with water when it is removed, by 
placing the thumb or finger over its larger opening. 

The tube now being filled with water, has its bevel-pointed extremity at once inserted 
into the opening already made in the vein, and is then entrusted to the care of an assistant 
(A), who carefully compresses the edges of the wound around the tube, and at the same time 
holds his thumb or finger over its larger opening to prevent the escape of the water. 

While the operator is performing this part of the operation, an assistant should prepare 
the arm of the blood-donor in the same manner as for venesection. An opening is then 
made into the vein, and the round-pointed or efferent tube at once inserted with its point 
toward the fingers. The donor should then be seated in a chair at the bedside of the patient. 
It is better not to secure the tubes in the veins by ligatures. B represents the hand of an 
assistant holding the efferent tube carefully compressed within the lips of the wound, in the 
same manner as with the afferent tube at A. 

The India-rubber portion of the apparatus, thoroughly cleansed, air perfectly expelled 
and completely filled with water, is now to be carefully and closely adjusted to the two tubes 
in the veins. When adjusted the stop-cocks are turned straight, and transfusion is commenced 
by first compressing the India-rubber tube on the efferent side (donor's), and then squeezing 
the bulb, which forces two drachms of water into the efferent vein. Next, while the bulb is 
compressed, shift the hand and compress the India-rubber tube upon the afferent (patient's) 
side. Then allow the bulb to expand slowly, and blood will be drawn into it from the donor's 
vein. When the tubing and bulbs are filled bring the hand back, compress the tube, follow 
this by compression of the bulb, and two drachms of blood will be thrown into the afferent 
vein. In this manner the process can be repeated any number of times desired, rapidly or 
slowly, and the exact amount of blood transfused can be known by counting the number of 
times the bulb has been emptied, one being subtracted, which accounts for water first used. 



78 



MATERIA MEDICA AND THERAPEUTICS. 



is more desirable and useful, and various arrangements of the 
Materia Medica have been attempted on this basis. They are all, 
to some extent, necessarily imperfect, owing partly to the diversified 
effects of medicines and partly to our ignorance of the real nature 
of many of the modifications which they produce upon the tissues. 
Still, the advantages of some arrangement of this kind are so numer- 
ous that it cannot well be dispensed with. 

The following classification will be found to include the more 
ordinary and generally received divisions of the Materia Medica, 
and to present the articles in convenient groups for therapeutic 
application, 

Medicines may be divided into — 

Narcotics, 
Anaesthetics, 
Antispasmodics, 
Tonics, 
Astringents, 
Stimulants, 
Sedatives, 
Spinants. 
Emetics, 
Cathartics, 
II. Those which have a special action on the secretions, or , Diaphoretics^— 
Eccritics (from 'ekkjuglq, secretion). Diuretics, 

I Blennorrhetics, 
*- Emmenagogues. 
Hematinics, 
Alteratives,, 
Antacids. 
Antiseptics, \ 
Irritants, 
Demulcents, 



I. Those which have a special action on the nervous system, 
or Neurotics (from vevpov, a nerve). 



III. Those which modify the blood, or Hematics (fi 
the blood). 



rom al/ua, | 



IV. Those which act topically. 



Coloring Agents, 
Anthelmintics. 



CLASS I.— NEUROTICS. 

ORDER I.— NARCOTICS. 

Narcotics (from vapxow, to stupefy) are medicines which impair 
or destroy nervous action. The primary effect of narcotics is, how- 
ever, of a stimulant character, and their therapeutic efficacy is in a 
great degree due to this action. They are often administered, too, 
for a true narcotic or sedative influence on the motor, sensory and 
intellectual functions. In diseased conditions, a marked tolerance 
of this class of medicines is established, and they can be exhibited 



NARCOTICS -OPIUM. 79 

in large doses without inducing narcosis. They are employed, 
chiefly, to remove muscular spasm, relieve pain, allay cerebral or 
spinal irritability, and procure sleep. 

When employed to relieve pain, they are termed anodynes ; 
when employed to procure sleep hypnotics or soporifics. 

When this class of medicines is resorted to for any length of 
time, with a view to a narcotic effect, their influence upon the system 
is much diminished, and constantly increased amounts are called for 
to maintain the same effect. 

OPIUM. 

Opium (from 07roc, juice) is the concrete milky exudation of 
the unripe capsules of Papaver somniferum (A T at. Ord. Papaveraceae). 

Fig. 5. 




POPPY-CAPSULE. 



The opium-poppy is a native of Persia, but is cultivated in various 
parts of Asia, in Europe, and in the United States. It is an annual 
plant, with a round, leafy stem, from two to four feet or more in height, 
and large four-petaled flowers. There are two prominent varieties 
of this species : the black poppy, with violet colored or red flowers, 
brown or blackish seeds, and globular capsules ; and the white 
poppy, with white flowers and seeds, and ovate capsules ; but these 
varieties run into each other under cultivation. 

The nearly ripe capsules (papaver) are from an inch and a 
half to two inches or more in diameter, and contain a good deal of 
opium. They are sometimes given to children in the form of syrup, 
and are applied externally as an anodyne emollient, in the form of 
decoction. The seeds are destitute of narcotic properties, and are 
used in Europe as an article of diet, and for the manufacture of an oil. 



80 MATERIA MEDICA AND THERAPEUTICS. 

Opium is obtained from incisions in the half-ripe capsules. The 
juice which exudes from the incisions is allowed to evaporate spon- 
taneously, and is scraped off after drying, generally with more or 
less of the epidermis, and is sometimes sent into the market un- 
mixed, as a choice variety. The opium of commerce is, however, 
commonly made by adding the dried juice, obtained by incision, to 
an extract prepared by expression, or even from a decoction of the 
leaves, the whole being kneaded together, formed into cakes, and 
wrapped in fresh poppy-leaves. 

The commerce of the United States is supplied with opium 
almost exclusively from Asiatic Turkey. This is known in the 
market as Smyrna or Turkey opium, and comes in Irregularly 
rounded or flattened cakes, covered with the capsules of a species 
of Rumex. 

A large amount of opium is produced in British India, for con- 
sumption in India and China, but it is not found in our markets. 
The Persian opium is another variety, as is that obtained from upper 
Egypt, but these do not reach the United States. 

The best opium should have a fine chestnut color, an aromatic, 
strong, peculiar smell and a dense consistence — becoming, however, 
harder and darker by being kept. It should be moderately ductile, 
break with a deeply-notched fracture, and, when drawn across white 
paper, should leave an interrupted stain. The taste is very bitter 
and somewhat acrid, and when chewed it excites irritation in the 
mouth and throat. It is inflammable, and imparts its virtues to 
water, alcohol and diluted acids, but not to ether. 

Chemical Constituents and Tests. — Opium contains a great 
variety of chemical constituents, the most important of which is the 
alkaloid Morphina (tnorphine). Other principles found in opium 
are the alkaloids, narcotiyie, codeine, narceine, paramorphine (the- 
baine), papaverine, pseudomorphine (phormine) ; meconin, meconic 
and thebolactic acids, gum, extractive, resin, oil, etc., but no tannin 
or starch, and, in very minute amounts, alkaloids, termed meconj- 
dine, laudamine, codamine, lanthopine, rhceadine, laudanosine, pro- 
topine, hydrocotarnine, deuteropine, oxynarcotine, gnoscopine, and 
cryptopine. Porphyroxin, so called by Merck, is not a proximate 
principle, but a complex substance, consisting of several alkaloids 
(Hesse). Morphine is the principle upon which the narcotic effects 
of opium essentially depend, and, with its salts, is official in all the 
pharmacopoeias. 



NARCO TICS— OPIUM. 81 

Morphine exists in opium chiefly in combination with meconic 
acid. The morphine meconate is separated from the other constitu- 
ents of the drug by successive macerations with water. Alcohol 
and water of ammonia are then added to the aqueous solution, by 
which the salt is decomposed, the ammonia precipitating the mor- 
phine and the alcohol seizing the coloring matter as soon as it is 
separated from the alkali. The crystals of morphine which are 
formed are afterwards boiled in alcohol, and the solution is filtered 
through animal charcoal. Good samples of opium, when dried, 
should yield not less than 12 nor more than 16 per cent, of morphine. 

Morphina {Morphine) (C 17 H 19 N0 3 .H 2 0) occurs in colorless, 
rhombic, prismatic crystals, without smell, but of very bitter taste. 
It is very slightly soluble in water and ether, nearly insoluble in 
chloroform, partially soluble in cold and more nearly soluble in 
boiling alcohol. Acetic ether (ethyl acetate) is the best solvent for 
it. From the insolubility of the alkaloid the salts of morphine are 
preferred for medicinal use ; they are freely soluble in water and 
diluted alcohol, but are insoluble in ether and chloroform. Tests : 
1. Concentrated ?iitric acid strikes with morphine and its salts a rich 
orange-red color, slowly fading to yellow ; this will detect gr. T o W in 
the dry state (Wormley). 2. Neutral solutions of ferric chloride or 
stdphate color them deep blue. Other tests are recommended, but 
these are the best. 

Narcotine (G^H^NO,-) exists in opium, chiefly in the free state, 
and, being insoluble in water, is left behind when the drug is macer- 
ated in this menstruum. It occurs in white, tasteless, inodorous, 
needle-like crystals, which are soluble in ether, alcohol, and still 
more so in chloroform. At one time it was thought to possess a 
portion of the narcotic properties of opium, but it is now admitted to 
be inert in this respect. Its salts, which are bitter, have been used 
in India as stomachics, and as febrifuge tonics in the treatment of 
intermittent fever. 

Codeina {Codeine) (C 18 H 21 N0 3 .H 2 0) exists in opium combined, 
like morphine, with meconic acid, and is extracted in the process for 
obtaining the latter alkaloid, from which it may be separated by an 
alkaline solution, which dissolves the morphine and leaves the co- 
deine. It occurs in colorless, octahedral crystals, of a bitter taste, 
soluble in water, alcohol, ether and chloroform. 

A T arceine (C^H^NOg) is obtained from the mother liquid left 
after crystallizing out the salts of morphine. C. Bernard affirms 
6 



82 MATERIA MEDICA AND THERAPEUTICS. 

that it is the most certain hypnotic of all the opium alkaloids. Da 
Costa's experience shows that it has little effect on skin or pupil, 
and that its hypnotic action is uncertain or inert, while Eulenberg 
asserts that to get its hypnotic effects it must be given in doses 
twice as large as morphine. 

Paramorphine (Thebaine) (C 19 H 21 N0 3 ) is said to be a tetanizing 
toxic agent, analogous in its effect to strychnine. 

Papaverine (C 21 H 21 N0 4 ) is said to produce some soporific action, 
with a sedative influence on the pulse ; its strength is from one- 
eighth to one-fourth of that of morphine. 

Cryptopine (C 2l H 23 N0 5 ) is thought to produce an hypnotic influ- 
ence analogous to that of morphine, though a much feebler agent. 
The statements in regard to the action of the last four alkaloids are 
conflicting. 

Meconic acid is inert, but is interesting as affording the most 
delicate test for opium ; ferric chloride or sulphate produces, with 
even very diluted solutions of opium, the blood-red color of ferric 
meconate, which is not discharged by diluted acids or corrosive 
sublimate. 

Incompatibles. — Alkalies, and astringent infusions containing 
tannic acid, are incompatible with opium ; the former precipitate 
morphine from its soluble combination, while the latter form with it 
an insoluble compound. Iodine and the iodides, bromine and the 
bromides (after standing) produce preciptates with the morphia 
salts, an iodide or bromide of the alkaloid being formed. A few 
drops of dilute HC1 acid added to the bromide mixture will effect 
solution. Sodium biborate throws down a precipitate with the salts 
of morphia, cleared up by boric acid. Many of the mineral salts are 
also decomposed by opium, as lead acetate (lead meconate and 
morphine acetate being formed). This chemical incompatibility, 
however, does not interfere with the physiological action of opium ; 
for instance, lead acetate and laudanum, though incompatible, pro- 
duce a local sedative effect ; moreover, lead acetate, opium or the 
morphine salts may be safely prescribed together in pill form. 

Aids. — Its hypnotic action is aided by the bromides, chloral, 
urethan, paraldehyd and hypnone ; its analgesic, by belladonna 
and cocaine, but it should not be prescribed in full doses with these 
agents. 

Contraindications. — It is positively contraindicated only 
where there is a tendency to apoplexy or coma, where the opium 



NARCO TICS— OPIUM. 83 

habit exists, where asphyxia is threatened by copious secretions in 
the air passages, or where there exists an idiosyncrasy with respect 
to its effects. 

Physiological Effects. — Opium exerts a marked therapeutic 
action in the relief of pain, spasm, wakefulness, nervous irritability, 
and certain forms of morbid discharge, especially from the alimentary 
canal, by a primary stimulant action, antecedent to any narcotic in- 
fluence. In such conditions a tolerance of its effects is established, 
and very large amounts may be taken without inducing narcosis. 
Opium applied locally deadens the sensibility of the nerves of a part 
without influencing the brain {Trousseau et Pidoux, vol. ii). In detail 
its physiological action in moderate doses is as follows : Nervous sys- 
tem : the cerebral functions are stimulated, accompanied by an agree- 
able exhilaration of the intellectual faculties, followed by drowsiness, 
consciousness being finally lost in sleep, the latter sometimes dis- 
turbed by dreams. Such sequelae as headache, nausea and consti- 
pation are common. The reflex function of the spinal cord is di- 
minished, and in lethal doses destroyed, death taking place from 
paralysis of the respiratory centre. Pupil : in full doses opium con- 
tracts the pupil; but, since the local application of morphine scarcely 
possesses this power, it follows that its action must be systemic, 
due probably to stimulation of the oculo-motor centres. Circula- 
tion: the heart's action becomes slower and fuller, from a depress- 
ing influence on the cardiac motor ganglia ; at the same time the 
arterial tension is raised. Respiration : this becomes slower, and 
the bronchial mucus is lessened. Secretions : the intestinal secre- 
tions are diminished, and, as peristaltic action is retarded, constipa- 
tion results; the urine is slightly diminished, as is also the saliva; in 
one word, all the secretions are lessened except that of the skin, 
which is increased. According to Phillips the drug is partly 
eliminated by the skin. In regard to its elimination by the kidneys, 
Eliasson's * conclusions are as follows, viz., that large doses only 
can be found in the urine, small being undetectable, though there 
appears with the latter in the urine a supposed morphia-derivative. 
In some persons an itching and miliary eruption of the skin occurs. 
Most of the opium alkaloids increase the excretion of urea. 

To sum up, opium, in man, expends its force chiefly on the 
higher cerebral centres, scarcely influencing the cord at all, unless 

* Beitrage zur Lehre von dem Schicksal des Morphins im Lebenden Organismus, 
Inaug. Dissertation, Konigsberg, 1882, von W. Eliasson. 



84 MATERIA MEDICA AND THERAPEUTICS. 

in full doses, while in the lower animals whose cerebra are undevel- 
oped, as the frog, it acts wholly on the cord, and in them, in the 
absence of a well-developed brain, hypnotism is unusual. Accord- 
ing to Fothergill, opium produces sleep by causing cerebral anemia 
and diminished activity of the cells; and is analgesic by lessening 
the conductivity of nerve-matter. 

Toxicology. — When a poisonous dose is taken, the stage of 
excitement is wanting ; giddiness and stupor rapidly come on, with 
diminution in the frequency, though not in the fullness, of the pulse; 
and these symptoms are soon followed by an irresistible tendency 
to sleep, and finally by coma. The breathing is heavy and stertor- 
ous, the pulse slow and oppressed, and the pupils are contracted. 
If relief be not afforded, the pulse sinks, the muscular system be- 
comes relaxed, and death ensues, preceded sometimes in children 
by violent convulsions. In adults even gr. J^ of morphine,* hypo- 
dermically, and gr. ivss. of opium, f have caused death, but such 
results are rare. On the other hand, enormous amounts (laudanum J 
fgvij, and in the case of a girl aged u.^, § fSxij) have been taken 
without fatal consequences. 

Antidotes. — In cases of poisoning from opium or its prepara- 
tions, the stomach should be immediately evacuated by the stomach 
pump, if possible, or by emetics. Owing to the torpor of the stomach, 
emetics are to be given in double the ordinary doses, and the direct 
emetics are to be preferred, as zinc sulphate (gr. xx-xxx) or copper 
sulphate (gr. v-x), in a tumbler of water. A large tablespoonful of 
mustard flour, or of powdered alum, answers very well as an emetic, 
orapomorphine hydrochlorate (gr. T V) maybe given hypodermically 
Every means should be taken to arouse the patient from his lethargy ; 
he should be kept awake, and made to walk as long as possible; after- 
ward cold affusions, counter-irritation to the nape of the neck and 
extremities, flagellation to the palms of the hands and soles of the 
feet, and, best of all when the coma is profound, the electro-magnetic 
battery should be resorted to, one electrode to be placed above the 
origin of the phrenic nerves, the other over the epigastrium. Arti- 
ficial respiration is also to be practiced. The use of strong coffee 
has proved efficacious ; and stimuli may be given to support the 

* Chicago Med. Exam., May, 1878, p. 493. 

f A Treatise on Poisons, 4th ed., p. 713, by Christison. 

\ Med.-Chir. Trans., Vol. I, p. 77. 

$ Guy's Hasp. Reports, XI, 1865, p. 287. 



NARCOTICS— OPIUM. 85 

system. It has been found that atropine exercises a powerful influ- 
ence as a physiological antidote to opium, these drugs acting in an 
opposite manner on respiration, brain, skin, pupil and circulation. A 
hypodermic injection of atropine sulphate, gr. ? V to ^> should be 
administered when there is any sign of the failure of respiration, 
and repeated in fifteen to thirty minutes, the frequency and dose de- 
pending on the condition of the respiration, not of the pupil or depth 
of coma. The poisonous action of opium appears to be entirely 
directed to the nervous system, since no local lesions are found 
after death. 

Opium is largely used as an habitual narcotic in Oriental coun- 
tries, and to some extent in Europe and the United States. The 
effects of indulgence in this species of intoxication are of the most 
destructive character upon both the physical and mental faculties. 
A confirmed opium smoker can be recognized, generally, by his 
pallor, emaciation, and contracted pupil. 

In China extensive establishments are devoted to the smoking 
of opium, a form of dissipation that has fewer evils following in its 
train than those caused by the abuse of alcohol ; in fact, the " pipe'' 
puts the smoker to sleep, and so effectually prevents the crimes so 
often induced by alcoholic inebriation. It is quite possible to indulge 
in the " pipe " and yet enjoy good health. In fact, there are many 
Chinamen who, smoking in moderation, experience no evil effects 
therefrom. In Japan opium smoking is unknown, as the importation 
of the drug is rigorously prevented by law. As opium is either taken 
by means of the pipe, hypodermic injection, or in solution, the ex- 
pression " opium eating" is a misnomer. 

Medicinal Uses. — Of all the articles of the Materia Medica, 
opium enjoys the widest range of therapeutic application. From 
its properties of assuaging pain and inducing sleep it is useful in 
almost all diseases, and should be given in doses sufficiently large 
to produce a decided effect. As an anodyne in all injuries, as sprains, 
railway accidents, burns, etc , to relieve pain and resist surgical shock, 
we have no substitute for opium ; and as an hypnotic in delirium 
tremens and in the insomnia and cerebral irritability of fever, mania, 
mania ct potu, hydrophobia and tetanus, either opium or morphine, 
the latter hypodermically, are equally invaluable. Prior to an opera- 
tion, to avert surgical shock, gr. J^-J^ of morphine may be thrown 
under the skin before etherization. In delirium tremens, when the 
arterial tension is high, to enhance its hypnotic effect, it is well com- 



86 MATERIA MEDICA AND THERAPEUTICS. 

bined with sedatives, as the bromides, chloral or aconite, as in the 
following: — ]^ Morphinae sulphatis, gr. %-%; chloral, gr. xv; 
syrupus tolutani, f5ss; aquae, ad f§ss, p. r. n. 

From its power of relaxing muscular spasm it is our most 
efficient resource in colic, either biliary, renal, intestinal or uterine, 
being preferably given hypodermically, and often with atropine. 

In acute dysentery, cholera and cholera morbus, opium forms the 
basis of every variety of treatment, partly for its diaphoretic effects, 
but principally for its action in arresting the intestinal secretions and 
peristalsis. In the collapse of cholera, Dr. Gallagher has derived 
great benefit from morphine subcutaneously. In dysentery, extract 
of opium gr. ss is given every two hours, continued until an im- 
pression is made, or it becomes contraindicated ; or laudanum may 
be combined in the first stage with castor oil or Rochelle Salt (see 
Sal Rochelle) ; again, opium is often added to astringents, vegetable 
or mineral, and lastly, it may be introduced within the rectum, either 
in starch-water or suppository, as a curative measure, or for the 
relief of tenesmus. In conjunction with the above treatment, the 
patient should be placed upon a stimulating fluid diet, as milk and 
brandy. In some cases of dysentery it has been found that opium 
causes retention of the dejecta, which, by fermenting, irritate the 
bowel, hence it may at times do harm.* In acute diarrhcea, prefer- 
ably after the exhibition of a cathartic, opium is indicated with a 
vegetable astringent : — Ity Tincturae opii deodoratae, tllx ; tincturae 
kino vel catechu, f5j-ij ; aquae cinnamomi, fgss. M. Sig. — Every 
three or four hours ; or if accompanied with flatulency — 1^ Extracti 
opii, gr. y^ ; pulveris camphorae, gr. iij ; oleoresini capsici, gr. ^ ; 
M. Ft. pil. No. i. Sig. — Every tbree hours. 

In that form of diarrhea where the motions quickly follow 
after eating it is particularly serviceable by restraining peristalsis, 
thus allowing time for digestion. In peritonitis, in which large 
amounts are well borne, morphine hypodermically should be admin- 
istered from the first, and the patient later kept narcotized by opium 
itself; while in puerperal septicemia it has been found more success- 
ful than any other remedy. In gastric irritability, to check vomit- 
ing, in colica pictonum, to relieve the pain of rheumatism and gout, 
opium or morphine are constantly employed, and hypodermics of 



*See the Med. and Surg. Hist, of Rebellion, chap, on Dysentery. 



NARCO TICS— OPIUM. 87 

morphine in myalgia, lumbago, torticollis, and the various neuralgias 
are the best means of alleviating the pain, and not infrequently effeet 
a cure. In meningitis^ cerebral and spinal, it is of the greatest value, 
no other drug being comparable to opium, of which gr. ss-ij may- 
be given hourly, so as to keep the patient thoroughly under its 
influence. In other convulsive diseases, such as uremic convulsions 
(Loomis) and puerperal eclampsia, it is an efficient remedy ; more- 
over, an approaching paroxysm of malarial fever, pernicious or 
intermittent, may be prevented, if necessary, by the timely injection 
of morphine. 

To check peristalsis and relieve pain opium or morphia are our 
most reliable agents in enteritis and typhlitis. In intestinal hemor- 
rhage they place the bowel in splints as it were and thus ensure 
that quietude which is so needful for repair, while in intussuscep- 
tion, as an aid to surgical measure, full doses of either, well com- 
bined with belladonna, are indicated to allay the pain and quiet the 
spasm. In the relief of of 'ter pains morphia or atropia are the best 
anodynes, care being taken to free the uterus of clots with ergot 
at the time of their administration. 

For the relief of the cough of pulmonary affections, as acute 
bronchitis, opium and morphia have no equal in the Materia Medica, 
but are generally contraindicated before the secretions are estab- 
lished, except in minute doses combined with a diaphoretic, as in 
Dover's powder. Good formulae are : 1^ Morphinae sulphatis, gr. 
ij ; syrupus ipecacuanhas f5ijss ; syrupus pruni virginianae, f^iij ; 
aquae ad fSyj. M. et Sig. — tablespoonful every three hours. ^ 
Tincturae opii camphoratae, glycerini, et syrupus pruni virginianae 
aa f5j. M. et Sig. — A teaspoonful, repeated as necessary. 

In the first stage of pleurisy, morphine hypodermically, together 
with aconite and a large dose of quinine per orem, and perhaps a 
blister, is the best means of relieving the pain and cough and hin- 
dering effusion. 

Morphine subcutaneously will generally relieve a paroxysm of 
astlima and angina pectoris, although without curative power, and 
Dr. Allbutt recommends it to alleviate cardiac dyspnoea, which state- 
ment the editor can confirm. Thus given it is the best remedy for 
nocturnal chordee. 

In sunstroke, too, good results have been obtained from mor- 
phine injections with antipyretic and sedative treatment (Dr. Jas. 
Hutchinson). Opium, and recently its alkaloid codeine, have been 



88 MATERIA MEDIC A AND THERAPEUTICS. 

highly lauded in the treatment of diabetes mellitus ; and, lastly, in 
gangrene its use is indicated. 

Caution must be enjoined in prescribing opium in chronic dis- 
eases for fear of originating the opium-habit, which may be con- 
tracted where there is much suffering, on account of the speedy 
relief afforded by it. 

Topically, it is used in the form of ointment to relieve the pain 
of boils, abscess, carbuncles and hemorrhoids, either alone or with 
belladonna: 3^ Extracti opii, extracti belladonnae aa gr. xxj ; acidi 
tannici gr. x ; adipis §ss. M. et Sig. — Apply to piles. In supposi- 
tory, it is serviceable both for its local and constitutional effects, in 
strangury, acute cystitis, anal fissure, proctitis, prostatitis, uterine dis- 
orders, as abortion, and to control chordee : 1^ Extracti opii, gr. j ; 
extracti belladonnae gr. ss. M. ft. supposit. no. I. As a sedative 
collyrium, in aqueous solution, with lead-water, as an anodyne lo- 
tion, or as an addition to poultices, it is daily employed. 

Administration. — The ordinary dose of opium as an anodyne 
and hypnotic is gr. ss— ij . Much larger doses are, however, called 
for in many diseases; and when it is administered for a length of 
time, as a narcotic, the dose must be gradually increased. To in- 
fants and very old persons it is to be given with great caution. 
Some of its disagreeable effects may be obviated by the addition of 
other remedies ; thus, if it constipate, by combining it with aloes, or 
if there be anorexia, with capsicum. 

The following are the official preparations of opium : — 

Opii Pulvis [Opium Powder), Used in making most of the 
opium preparations. It should contain not less than 12 nor more 
than 16 per cent, of morphine. This, as Dr. Squibb has pointed out, 
causes a great variation in their strength, depending on the percent- 
age of morphine in the powdered opium ; thus laudanum f5j may 
contain from gr. 5.44 to gr. 7.25 of morphine. 

Opium Denarcotizatum [Denarcotized Opium) Opium freed 
from narcotine, etc., by means of ether, and containing 14 per cent 
of morphine. Dose, gr. ss— ij. 

Pilule© Opii {Pills of Opium). Each pill contains gr. j. 

Extractum Opii [Extract of Opium). Dose, gr. \. 

Trochisci Glycyrrhizee et Opii [Troches of Glycyrrhiza and 
Opium). Wistars cough lozenges; are very useful to allay irritative 
laryngeal or pharyngeal cough and hoarseness. Each troche con- 
tains gr. ^V of extract of opium. 



NARCOTICS— OPIUM. 89 

Emplastrum Opii {Opium Piaster). Made by mixing extract of 
opium with Burgundy pitch and lead-plaster. Useful to allay the 
pain of boils. 

Pulvis Ipecacuanhas et Opii. Poivder of Ipecac a?id Opium. 
Dover s Poivder is a most valuable anodyne diaphoretic, extensively 
prescribed in the early stages of acute diarrhoea, dysentery, rheuma- 
tism, bronchitis, pneumonia, acute nasal catarrh, etc. Dose, gr. x, 
containing gr. j of opium and ipecac each. 

Tinctura Opii {Tincture of Opium) Laudanum. Contains 10 
per cent, of powdered opium. It should be recollected that the 
opium from which these preparations are made contains from 2 to 6 
per cent, more morphine than that formerly employed. This is the 
most commonly used of all the official preparations of opium. 
When long kept, particularly if exposed to the air, it becomes thick 
from evaporation of the alcohol, and its strength is much increased. 
Dose, Hlxij, or about 25 drops, equivalent to opium gr. j. There 
are 120 drops in f5j. To relieve the pain of earache the introduc- 
tion of hot laudanum and olive-oil within the external auditory canal 
is a good remedy. Laudanum is much used in the form of enema. 
(See enemata). 

Tinctura Ipecacuanhas et Opii {Tincture of Ipecac and Opium). 
Dose, TTLx-xx. 

Tinctura Opii Camphorata (Camphorated Tincture of Opium). 
Paregoric Elixir. Contains opium in diluted alcohol, with benzoic 
acid, oil of anise, glycerin and camphor. Dose, f5ss, or a table- 
spoonful, containing rather less than a grain of opium. A favorite 
preparation for children, and particularly serviceable in cholera in- 
fantum and bronchitis. From 5 to 20 drops may be given to an infant. 

Tinctura Opii Deodorata {Deodorized Tincture of Opium). In 
preparing it, the narcotine and odorous ingredients of opium are 
got rid of. A valuable preparation. Dose, Ttlxij. 

Acetum Opii {Vinegar of Opium). Black Drop. Dose, Iflxij. 

Vinum Opii ( Wine of Opium). Sydenham 's Laudanum. Dose, 

mxij. 

Morphinae Sulphas {Morphine Stdphate), Morphinae Acetas 
{Morphine Acetate), Morphinae Hydrochloras {Morphine Hydrochlo- 
rate), are the official salts of morphine, made by saturating the 
alkaloid with sulphuric, acetic or hydrochloric acids. The sulphate 
and hydrochl orate occur in the form of snow-white, feathery crystals, 
the acetate (which is not very stable) as a white powder. They 



90 MATERIA MEDICA AND THERAPEUTICS. 

have a bitter taste, are all freely soluble in water and alcohol, and 
produce analogous medicinal effects; the sulphate is most em- 
ployed in this country. The salts of morphine possess the analgesic 
and hypnotic, but not the diaphoretic properties of opium, and are 
considered less apt to produce headache, nausea or constipation. 
They are peculiarly adapted to the hypodermic and endermic methods 
of application. Dose, gr. \-\, equal to opium gr. j. Magendie's 
solution, not official, used hypodermically, contains gr. xyj to f§ ; 
but for this purpose compressed tablets, or the powder dissolved in 
water as required, are preferable, and its efficiency is often promoted 
by the addition of atropine. 

Troches of Morphine and Ipecac (Trochisci Morphinae et Ipe- 
cacuanhas) ; each troche contains gr. ? V of morphine sulphate and 
gr. T V of ipecac. 

Pulvis Morphinae Compositus {Compound Powder of Morphine) 
(Tull/s Powder). Contains morphine sulphate (i part), mixed with 
camphor, liquorice and calcium carbonate (of each 20 parts). 

Codeina [Codeine) is official, and. has been found to possess 
uncertain narcotic powers, gr. j having failed to be hypnotic, while 
gr. iv have caused insomnia and slight delirium ; * again, gr. v have 
produced no effect (S. Weir Mitchell). It may be used as an ano- 
dyne and hypnotic, and appears to have a sedative effect on the 
vagus also. It has been used with success in gastrodynia, to allay 
troublesome cough, and is said to be of service in diabetes mellitus. 
Dose, gr. ss-ij, in water, with elixir of orange. 

LACTUCARIUM. 

Lactucarium {Lettuce Opium) is the concrete milk-juice of 
Lactuca virosa, the garden-lettuce [Nat. Ord. Composite), and is 
obtained from incisions in the stem of the plant, during the period 
of inflorescence. Two varieties are found in the market : English 
and German lactucarium, the latter being inferior. It occurs in 
small, brownish lumps, with an opiate smell. The bitter principle, 
termed lactucin, is said to possess less hypnotic power than the crude 
drug. 

Effects and Uses. — Lactucarium possesses very feebly the 
anodyne and hypnotic qualities of opium. It may be given where 
opium disagrees from idiosyncrasy. Dose, gr. x; of the syrup 
f5ij-iv ; of the fluid extract f5j. 

* British Medical Journal, 1874, 1, 478. 



NARCOTIC&-PARALDEHYD. 91 



PARALDEHYD. 



This remedy, not official, is a polymeric modification of ethyl 
aldehyd (C 2 H 4 0) 3 , and is formed by treating it with a mineral acid. 

It is a colorless liquid, boiling at about 25 5 ° F. and solidifying 
into fusible crystals at 5 I ° F. It has an acrid taste, a volatile odor 
like that of chloroform, is more soluble in cold than in hot water, 
and has a sp. gr. of .998. 

Aids. — Morphia, urethan, and hypnone. 

Physiological Effects. — The action of paraldehyd has been 
studied by Drs. Cervello,* Morselli,f Albertoni, { S. A. PopofT,§ 
Andruzski,|| Carl von Noorden,1f Berger, Langreuter,** Dana and 
others, all of whom agree that it is hypnotic and sedative, lowers 
reflex activity, and is comparatively free from unpleasant after-effects. 
Locally : it is strongly antiseptic and anti-fermentative. Nervous 
system : the action of paraldehyd is exerted on the hemispheres, 
medulla and cord, in the order named (Coudray).ft 

Small doses cause a temporary increase followed by depression 
of the excitability of the cerebral cortex, and quiet, tranquil sleep. 
When a large dose is taken the primary stimulation is absent. The 
pupils are unaffected. Paraldehyd depresses and in toxic doses 
paralyzes the respiratory centre of the medulla. The reflex centres 
of the cord and the peripheral endings of sensory nerves are de- 
pressed, causing a diminution, and, if a toxic dose have been taken, 
a subsequent loss of sensibility, reflex action, and voluntary motion ; 
the excitability of the motor nerves and of the striated muscles 
remains unimpaired. 

Circulation : even large doses do not affect the circulation nor 
the arterial tension. If, however, toxic doses be administered the 
cardiac frequency is at first decreased but soon increased, the indi- 
vidual beats becoming weaker than normal, a gradual fall taking 
place in the blood-pressure, the heart finally stopping in diastole. 

* Archiv. Ital. de Biologie, 1884, p. 113. Archlv. pour le Science Med., Vol. VI. El 
Pisani, Disp. IV, v and VI. 

t Gazz. degli Ospitali, Jan., 1883, Nos. IV, V and VI. Rev. Sper. di Fren e di Med. 
Leq., 1882. El Pisani Fasc, iii, loc. cit. 

X Riv. di Chim. Med. e Farmaceu-tossico e Farmaco., Feb. and Mar., 1883. 

|| Meditz. Obozre?tie, Fasc. I, Vol. XXI, 1884, p. 69. 

fyArkhiv. Psykhiatr'iee, etc., Vol. IV, Fasc. I, 1884, p. 1. 

^ Centralbl.j'ur Klin. Med., March 22, 1884. 

** Centralbl.fur Klin. Med., loc. cit. Berlin. Klin. Wochensch., June 16, 1884. 

ft These de Paris, 1886. 



92 MATERIA MEDIC A AND THERAPEUTICS. 

It is said that the cardiac arrest is only due to cessation of the re- 
spiratory act and that it may be prevented by resorting to artificial 
respiration. 

Respiration and temperature : more or less marked slowing of 
respiration always occurs, and if a sufficiently large dose be taken, 
there is final respiratory paralysis of central origin. The tempera- 
ture is slightly lowered. 

Alimentary tract : as a rule, no gastro-enteric disturbance oc- 
curs on waking; but if the dose be large and the medicine adminis- 
tered for a prolonged period, gastric catarrh and disordered nutrition 
may result (Andruzski), though most observers have not seen these 
effects following its prolonged use. Secretion : the urineis increased 
in amount. Prof. Popoff found that large intravenous injections de- 
stroyed the red corpuscles and produced hematuria. Elimination 
takes place through the kidneys and the lungs, the odor of paralde- 
hyd having been detected in the breath twenty- four hours after its 
administration. 

Medicinal Uses. — Paraldehyd is contraindicated in irritable 
states of the throat and stomach by reason of its acridity. It is 
chiefly used as an hypnotic in the insomnia of various mental disor- 
ders, or in insomnia from prolonged mental work, or where other 
hypnotics have proved insufficient or are contraindicated. Its 
good effects are especially conspicuous where insomnia is not due 
to pain or to mechanical causes, such as dyspnoea or cough. In 
the insomnia of acute or chronic mania, delirium tremens, dementia 
paralytica, hysteria, etc., it is useful by procuring sleep, but other- 
wise exerts no influence upon the disease. 

It has also been used with occasional benefit as an anodyne 
and hypnotic in neuralgic affections (Morselli). From its depressing 
influence on the reflex functions of the cord it has been given in 
epilepsy, and according to Riggi, is as useful in this affection as 
potassium bromide. 

Cervello found that paraldehyd was a physiological antagonist 
to strychnine, preventing the toxic symptoms of that alkaloid if 
given before their appearance or causing their subsidence if admin- 
istered after their development, and acting whether used with, before 
or after strychnine. This action is not reciprocal, as strychnine 
appears to exert little or no influence over paraldehyd-narcosis. 

Administration. — Dose, f5ss-ij. It is best given in small 
amounts repeated every hour as required, than in a single large dose 



NARCO TICS—SULPHONAL. 93 

(Strahan) ;* more than gtt. lx are rarely required to produce sleep. 
Paraldehyd may be administered in capsule or emulsified with acacia 
and syrup of almonds, which disguises somewhat its unpleasant 
taste. It has also been exhibited in suppository. 

SULPHONAL. 

This substance (not official), discovered by Bauman in 1886, is 
produced by the reactions ensuing between ethyl hydrosulphide, 
acetone and sulphuric acid, in which diethyl-sulpho-dimethyl- 
methane (C 5 H 12 4 S 2 ) is formed. It is obtained in colorless, inodor- 
less, insipid, prismatic crystals, almost insoluble in cold water, but 
miscible in boiling water, 1 to 15, remarkable for its stability, and 
the resistance it opposes to alkalies, acids (except H 2 S0 4 and HN0 3 ) 
and oxidizing agents. 

Incompatibles. — On account of its insolubility in the ordinary 
menstrua it should be prescribed alone. 

Aids. — Morphia increases its hypnotic effect and may be given 
with it in the same capsule. 

Physiological Effects. — The action and uses of sulphonal 
have been carefully studied by Egasse,f Hogarth,! and Schick,§ the 
latter experimenting upon frogs and rabbits by hypodermic injection. 
Egasse finds that unlike paraldehyd and chloral it does not disturb 
digestion, alter the blood-pressure, nor affect the respiration of dogs, 
even in toxic doses, though it induced profound sleep. Upon canine 
locomotion a large quantity causes trembling of the gait, locomo- 
tion being difficult, the animal finally sinking into deep slumber. 
Schick concludes, after a number of experiments by his method, that 
it does not affect the motor-nerve irritability, the sensory nerves, or 
cardiac action, beyond a slight acceleration, but that it lowers reflex 
activity, quickens the pulse slightly, raises the arterial tension, and 
depresses respiration, the latter uninfluenced by section of the vagi. 
Sulphonal is eliminated by the kidneys as an organic sulphide, not 
yet isolated, without altering the quantity of nitrogenous matters 
excreted in the urine. 

Toxicology. — Toxic doses cause painful convulsions, muscular 
resolution, stupor and death. An autopsy made upon animals killed 



* Lancet, London, Jan. 1885. 

f Bull. Gen de Therap., 1889, P- 2I °- 

\ Lancet, London, Oct. 12, 1889. 

\Journ. of Nervous and Mental Dis., 1889, p. 32. 



94 MATERIA MEDICA AND THERAPEUTICS. 

by sulphonal showed violent congestion of the kidney-medullary 
substance, as well as the same condition about the cerebral and 
spinal meninges. A fatal instance* is reported of poisoning by 
sulphonal, which, however, must be considered as most unusual 
considering the quantity swallowed, of a woman who succumbed to 
two doses of gr. xv each, taken at intervals of I % hours. Pro- 
found sleep ensued, followed by failure of respiration, and death in 
40 hours. 

Medicinal Uses. — The use of this medicament is limited to the 
production of sleep, and to calm excitement as in simple insomnia, 
acute mania, dementia, alcoholism, neurasthenia and melancholia. Its 
action is usually slow, at times wanting. It possesses no analgesic 
power. Such sequelae, after awaking, as fatigue and continued som- 
nolence have been noted. 

Administration. — By reason of its insolubility, it may be 
given in capsule, previously well pulverized, and should be taken 
after a meal, about 2 hours prior to the required sleep. Dose for 
infants, gr. iii-vi ; adults, gr. xv-xxx. . 

HYPNONE. 

This substance (not official), phenyl-methylacetone, acetophe- 
none, or acetaphone, is a recent addition to the narcotic group of 
remedies. It is a fluid having a sp. gr. of 1.032, crystallizing in 
large flakes at about 50 F. Its properties have been investigated 
by PopofT, Dujardin-Beaumetz, Laborde,f MagmenJ and others, 
who have ascertained that it possesses decided hypnotic properties. 
Injected into the vein of a dog it caused sleep, analgesia, absence of 
the ocular reflex, dilated the pupils, and killed by asphyxia (La- 
borde). It is eliminated in part by the lungs, its odor being per- 
ceptible upon the breath. Large doses are said to irritate the stomach. 
What the toxic dose is has not yet been determined, though as much 
as gtt. vj-viij have been taken without disagreeable effects. 

It is probably indicated in the same range of diseases to which 
paraldehyd is applicable, especially in uncomplicated insomnia. 
Dose, gtt. ij-v, or perhaps more, in capsule or with glycerin and 
syrup. 



* Med. News, Aug. 10, 1889. 

f Compt. Rend, des Seances de la Soc. de Biol., t. II, Oct., 1885. 

% These, Lyon, 1886. 



NARCOTICS— URETHAN. 95 

URETHAN. 

Urethan (C 3 H 7 N0 2 ), not official, is ethyl carbamate and occurs in 
white crystals, odorless, almost tasteless, and readily soluble in water. 
Its effects have been studied by Gamier,* Hiibner and Strieker, f and 
others. It acts principally on the cerebrum, at first stimulating but 
soon depressing its functions and inducing, in suitable cases, tran- 
quil sleep, usually without unpleasant after effects. According to 
Gordon's! investigations the circulation and respiration are some- 
what depressed, the reflexes lowered. Small quantities (gr. v-x) 
increased the excretion of urea, while large diminished it, with no 
effect on animal heat. It is not an analgesic, and will not produce 
sleep when insomnia is due to pain. It is feebly toxic, causing in 
overdoses insensibility and coma, though 5iij have been taken with- 
out alarming results. Large doses of urethan decrease the nitro- 
genous elements of the urine, by which fluid it is excreted (Gamier). 
Medicinal Uses. — As an hypnotic it is useful in simple insomnia 
when other remedies are contraindicated on account of their action 
on the heart and respiration. It has been given also with benefit in 
epilepsy, chorea and uremic convulsions. In large doses it is an- 
tagonistic to strychnine, but is not sufficiently powerful to be used 
as an antidote to that poison. The dose ranges from gr. ij-5j, or 
more, dissolved in water and flavored with elixir of orange. Hyp- 
notic effects can usually be produced by doses of gr. xv-xxx in 
suitable cases. Capsules may be used as a means of administration. 

BELLADONNA. 

Belladonnse Folia, Belladonna Leaves; Belladonnse Radix, Belladonna Root. 

Atropa Belladonna, or Deadly Nightshade {Nat. Ord. } Solan- 
aceae), is a European perennial plant, with herbaceous, branched 
downy stems, about three or four feet high, large ovate leaves of a 
dull-green color, and drooping, bell-shaped purple flowers. The 
whole plant possesses narcotic properties, but the leaves and root 
only are official. The root should be obtained from plants more 
than two years old ; the dried root is long, round, from one to seven 
inches in thickness, branched, of a reddish-brown color, of little odor, 
and a feeble sweetish taste. 



* Revue Med. de l'est y 1886, p. 126. 

f Deutsche Med. Wochensch., April, 1886, p. 236. 

\ Brit. Med. Journ., Nov. 2, 1889. 



96 



MATERIA MEDIC A AND THERAPEUTICS. 



Chemical Constituents and Tests. — The physiological prop- 
erties of belladonna depend on the presence of an alkaloid termed 
atropine, combined with malic acid, which is found in all parts of the 
plant. It is official, and is prepared from the root by exhaustion 
with alcohol, afterward adding sulphuric acid, precipitating with 
potassa, dissolving the atropine in chloroform, and then evaporating 
the chloroform. Atropina {Atropine) (C^H^NOg) occurs in the form 
of yellowish-white, silky, prismatic crystals, without smell, but of a 
bitter, acrid taste, soluble in alcohol, more so in ether, still more so 
in chloroform, but only partially soluble in water. The best test is 
bromine, in hydrobromic acid, which produces a yellow amorphous 
precipitate, soon becoming crystalline, and will detect -at least gr. 
2Tiyoo (Wormley) ; auric chloride gives with atropine solution a yellow 



Fig. 6. 




ATROPA BELLADONNA 



ROOT ; B, LEAVES. 



amorphous precipitate ; the physiological test should also be applied 
by dilating the pupil of a rabbit or a cat by local application to the 
eye. It is a most energetic poison, producing analogous effects to 
those of belladonna, but much more powerful. Another alkaloid 
termed belladonnine has been isolated, which, according to Laden- 
burg, is isomeric with hyoscyamine and atropine. It has, however, 
a lower fusing point, and yields a different salt with gold chloride. 

Incompatible^.— Prolonged contact with the caustic alkalies 
decomposes atropine and its salts, ammonia being liberated. The 
alkaloids atropine, hyoscyamine and daturine, alone or combined, 



NARCOTICS— BELLADONNA. 97 

are incompatible with tannin and vegetable infusions containing the 
same, an insoluble tannate being formed. 

Aids. — Stramonium, hyoscyamus and duboisia possess analo- 
gous effects. 

Physiological Effects. — The authorities consulted for this ar- 
ticle are Meuriot, * Fraser, f Bezold and Bloebaum,J Lemaitre, § and 
Bonders. || Belladonna or atropine applied locally diminishes sensa- 
tion and can be absorbed through the unbroken skin. Brought in con- 
tact with the temporal region belladonna causes dilatation of the pupil ; 
and accompanying its mydriatic action there is paralysis of accom- 
modation and a diminished intra-ocular pressure. Nervous system : 
in small doses it is a cerebral exhilarant, tending in larger doses to 
produce hallucinations and delirium. The exact quantity required 
to induce these effects cannot be stated, as individual susceptibility 
differs. Belladonna dilates the pupil, in whatever way exhibited. 
When dropped into the eye it brings about dilatation probably by 
paralysis of the end-organs of the third nerve and stimulation of the 
sympathetic, while internally it is also thought to cause pupillary dila- 
tation by a local action. In large doses the excitability of the motor 
and sensory nerves is impared by this drug, but the contractility of 
striated muscles remains unaltered. It tetanizes the cord, and 
heightens its reflex function (Ringer, nth ed., p. 401). Circula- 
tion : it increases the heart's movements by stimulating the cardiac 
ganglia of the sympathetic and paralyzing the peripheral ends of 
the pneumogastrics, and as it excites the vaso-motor centre, an in- 
crease in blood-pressure also takes place. Respiration : this is quick- 
ened by stimulation of the respiratory centre. Temperature : in 
small doses it raises the temperature and in large, reduces it. Secre- 
tion : belladonna checks the salivary secretion by paralyzing the 
peripheral endings of the chorda tympani nerve in the submaxillary 
gland, hence the dryness of the mouth and throat experienced after 
its use. Its effect on the urinary secretion is doubtful, but it un- 
questionably augments the solids ; it effectually checks the perspira- 
tion by a local paralyzing action on the peripheral nerve-end organs ; 
upon the intestinal glands its action is uncertain, though it certainly 



*" De la Method. Phys. de la Belladonne," 1868 ; an elaborate monograph. 

f Trans. Roy. Soc. Edin., 1869, p. 449. 

% Wurzburger Physiol. Untersuchungen, 1867, p. 3. 

§ Arch. Gen. de Med., VI, 6 ser., p. 173. 

;| " Accom. and Refrac. of the Eye," 1864, p. 558. 

7 



98 MATERIA MEDIC A AND THERAPEUTICS. 

induces intestinal peristalsis. Atropine is eliminated by the kidneys. 
Belladonna, however used, has the power to check the secretion of 
the mammary glands. In larger doses it causes dilatation of the 
pupils, loss of vision, giddiness, constriction of the throat, difficulty 
of deglutition and articulation, increased heart-action, quickened 
respiration, elevation of temperature, nausea, with occasional vomit- 
ing and purging, and sometimes a red eruption. 

Toxicology. — When excessive doses are taken the temperature 
of the body falls, the muscular system is relaxed, sensation is im- 
paired, the pulse fails, and maniacal delirium sets in, followed by 
coma, syncope and death, often preceded by convulsions. The fatal 
dose of atropine cannot be precisely stated, as death has followed 
gr. T V per orem,* while recovery took place after swallowing gr. jss, 
and gr. xxx-xxxv of the extract of belladonna taken by a child in 
mistake for liquorice, f Post-mortem examinations show that the 
action of the poison is not confined to the cerebro-spinal system, 
there being evident inflammation of the digestive organs. 

Antidotes. — Poisoning by belladonna is treated by evacuation 
of the stomach, cathartics, and, if coma occur, by the electro-mag- 
netic battery. Pilocarpine and physostigma are the physiological 
antidotes, or hypodermic injections of morphine may be adminis- 
tered for their stimulating effect upon the respiratory centres (see 
opium). As atropine and its salt is decomposed and rendered inert 
by prolonged contact with the caustic alkalies, the solutions of po- 
tassa and soda are recommended as antidotes for belladonna; with 
tannin an insoluble tannate is formed. 

Medicinal Uses. — Belladonna is one of our most highly 
esteemed anodyne and antispasmodic remedies. It is destitute of 
hypnotic effect, and, on the contrary, has a tendency to occasion 
wakefulness. In the treatment of neuralgia (extract, gr. ss) it ranks 
at the head of the narcotics, and is extensively employed both alone 
and with quinine sulphate (gr. x) and general tonic treatment. In 
myalgia, lumbago and sciatica, the subcutaneous injection gives 
speedy relief and may be advantageously combined with morphine. 
It should be given until dryness of the throat, dilatation of the pupil, 
or some disorder of vision are produced. Its powers of allaying 
spasm have been found very efficacious in the treatment of whoop- 



* Journ. de Chimie Med., i860, p. 529. Roux. 
I Cincinnati Lancet and Observer, 1861, p. 609. 



NAR CO TICS— BELLA D ONNA . 99 

iug-cough, in which atropine sulphate gr. ^ may be given in water 
once daily to children of from one to four years of age, diminished or 
increased according to the severity of the paroxysms and the effect 
produced. In asthma, a nightly dose at bedtime large enough to 
produce constitutional effects often prevents the paroxysm and, in 
some cases, cures the disease. In colica pictonum (see lead) and in 
laryngismus stridulus, belladonna ranks among the best antispas- 
modic remedies. In the latter disease, combined with the bromides, 
and, in the absence of laryngitis, repeated sponging of the neck 
with cold water, it is most efficacious. Prescribed with ergot it is 
often serviceable in exophthalmic goitre. 

Combined with opium in suppository, it is used for the relief 
of dysmenorrhcea, but is only palliative, as the treatment of this 
symptom depends upon its cause. It has been occasionally em- 
ployed with advantage in epilepsy. As a stimulant to the circula- 
tory system, it may be used wherever syncope is threatened from 
cardiac failure. By its influence in relieving irritability of the blad- 
der, it is probably the best remedy for the nocturnal incontinence of 
urine of children, for which purpose gtt. iij-v of the tincture may be 
cautiously given three or four times a day, and the child waked at 
midnight to pass water. 

In habitual constipation due to atony of the muscular fibre, after 
a dose of castor oil, the following is efficacious to reestablish peri- 
stalsis : 1^ Extracti belladonnas gr. 2V '■> aloin gr. tz ) extracti nucis 
vomicae gr. f. M. ft. pit. 1. S. one pill after meals t. d. for some 
time. Hypodermic injections of atropine gr. j'nV are useful in 
checking colliquative night-sweats, especially in phthisis, and may 
be advantageously combined with minute doses of morphine, to re- 
lieve the cough ; the following also is a good combination : ty 
Atropinae sulphatis gr. T V; strychninae sulphatis gr. \\ codeinae 
gr. x; aquae fgiiss. M. S. teaspoonful morning and evening. 
Hypodermics of atropine, well combined with ■ morphia, are often 
serviceable in spinal irritation and torticollis, and should be injected 
near the seat of pain. 

And, lastly, from its anhydrotic action, atropine is useful in mer- 
curialismus. 

As a topical remedy, belladonna is employed as an anodyne to 
carbmtcle, boils, and abscess, and also to relieve rigidity of the os uteri 
in labor, and in spasmodic urethral stricture, the application of the 
ointment to the constriction by a bougie is efficacious. A plaster, 



100 MATERIA MEDICA AND THERAPEUTICS. 

ointment or solution of atropine may be applied to the breasts of 
nursing women as a galactafuge ; while the plaster alone, to the 
back, often relieves lumbago and sacralgia. The liniment may be 
used to relieve rheumatism, muscular or gonorrheal, neuralgia and 
other local pains, and is advantageously combined with fluid ex- 
tract of aconite as a topical remedy in severe neuralgia. A sup- 
pository (gr. ss-j of the extract) is often sufficient for the relief of 
strangury, and to allay the hyperaesthesia about the prostate and 
deep urethra in spermatorrhoea, and in acute cystitis this, combined 
with a milk diet and rest in the recumbent posture, at the same time 
keeping the urine alkaline by liquor potassae, is one of the best 
plans of treatment. The local use of atropine in diseases of the eye 
is of the greatest importance ; solutions of the alkaloid or its sul- 
phate (gr. i-ij to f§ss. of water), may be dropped into the conjunc- 
tival sac, to relieve pain and photophobia, to determine the refraction 
of the eye from its influence on accommodation, in the diagnosis of 
suspected cataract, in operations for cataract, prolapsus iridis, and 
ulcers of the cornea. A good treatment for iritis is the instillation 
of atropine solution until the pupil is widely and evenly dilated, at 
the same time giving mercury internally, and continuing all until 
the danger of synechia is passed. Gelatin-wafers, containing gr. 
5V to T i^ of atropine, are used to dilate the pupil for ophthalmic pur- 
poses. It should be recollected that the local application of bella- 
donna, or its alkaloid, may produce the constitutional effects of the 
drug. 

Homatropine, — This is made from tropine amygdalate and 
dilute hydrochloric acid, atropine having been split into tropine and 
tropic acid. It is similar in its effects to atropine, though weaker, 
retarding the heart's action, and rendering it irregular. Applied to 
the pupil, it quickly bring brings about wide dilatation, and, more- 
over, is unirritating, hence it is an acquisition in ocular therapeutics, 
as iritis and prolapsus iridis. 

Administration. — The dose of the powder of the root or leaves 
is gr. j, to be repeated and increased till dryness of the throat, dila- 
tation of the pupil, and dimness of vision are produced. The 
abstract is twice as strong as the powdered root, from which it is 
prepared. The tincture (15 parts of the leaves to diluted alcohol q. 
s. to make 100 parts of tincture — dose, gtt. 15 to 30) and the alco- 
holic extract are also official. Of the fluid extract of belladonna 
root the dose is TT|j-v. For external use, a plaster (emplastrum bel- 



NARCO TICS— STRAMO XII T M. 



101 



ladonncc), an ointment [unguentum belladonna \ a useful anodyne ap- 
plication in adenitis, herpes zoster, chilblain and with opium, to hem- 
orrhoids), and a liniment (linitnentwm belladonna, containing fluid 
extract 95 per cent., and camphor 5 per cent.) are employed. 

Atropina {Atropine), or its official salt Atropine Sulphas 
{Atropine Sulphate), is generally employed medicinally instead of 
belladonna, as it represents the activity of the drug, because of the 
smallness of the dose required, and its fitness for hypodermic use. 
The sulphate, which is obtained by mixing the alkaloid with water, 
and gradually adding diluted sulphuric acid until the alkaloid is 
dissolved and the solution neutral, when the salt is obtained by 
evaporation, consists of a white, slightly crystalline powder, very 
soluble in water and alcohol, but insoluble in ether. As a medicinal 
agent, the salt is preferable because more soluble. Dose, gr. T io— <rV 

STRAMONIUM. 
Stramonii Fclia, Stramonium Leaves ; Stramonii Semen ; Stramonium Seed. 

Datura Stramonium, or Thorn-Apple, sometimes called James- 
town weed {Nat. Ord. Solanaceae), is an annual indigenous plant, 
which grows very abundantly in wa^ste grounds in all parts of the 

Fig. 7. 




DATURA STRAMONIUM. A, SEED. 



world. It has a forked, branching stem, from three to six feet high, 
ovate, toothed leaves, large funnel-shaped white or purplish flowers, 
which appear in midsummer, and ovate capsules, filled with numer- 



102 MATERIA MEDICA AND THERAPEUTICS. 

ous kidney-shaped, brownish-black seeds. The odor of the plant 
is strong and disagreeable, and its taste bitter and nauseous. It 
loses these properties very much when dried, but the process does 
not appear to weaken its narcotic qualities. The leaves and seeds 
are official, but the seeds are most powerful from containing most 
daturine. 

Chemical Constituents. — The active principle of Stramonium 
is an alkaloid termed daturine, found combined with malic acid, 
which is chemically identical with atropine, and possesses analogous 
properties. 

Physiological Effects. — The action of stramonium is closely 
allied to but weaker than that of belladonna. From its common 
occurrence in every part of the country, cases of poisoning from this 
weed are very frequent, particularly with children, who are fond of 
swallowing the seeds. A case is reported by Calkins * of a boy 
aged four years, who swallowed a tablespoonful of the seeds, but, as 
he soon vomited them, no ill effects resulted. The treatment laid 
down for the relief of poisoning from- belladonna is applicable to 
these cases. It is eliminated f by the urine. 

Medicinal Uses. — It is sometimes prescribed internally 'in neu- 
ralgia; and in asthma, gr. xxv of the dried leaves are smoked with 
great relief in cigarettes or pipes, the smoke being drawn into the 
lungs and the inhalation frequently repeated. Topically, daturine is 
occasionally used by oculists to dilate the pupils when other mydri- 
atics cannot be employed. Stramonium is an excellent anodyne 
application, in the form of cataplasm and ointment, to irritable 
ulcers, bed-sores and hemorrhoids. 

Administration. — The dose of the powdered leaves is gr. ij ; 
of the seeds, gr. j, to be repeated and gradually increased till effects 
are produced. Dose of the extract (of the seed) gr. y 2 . The fluid 
extract (dose TTUj-v), the tincture (10 per cent, of the seed, dose 
TTLv-xxx), and the ointment , made by mixing the extract with ben- 
zoinated lard, are also official. 

hyoscyamus. 

Hyoscyami Folia, Hyoscyamus Leaves. 

Hyoscyamus niger, or Henbane {Nat. Ord. Solanaceae), is a 
native of Europe, and is naturalized in the northern parts of the 

* Am. Med. Monthly, 1856, p. 220. 

f Arch, de Physiologie Norm, et Pathol., t. iii, 1870, 215. Oulmont et Laurent; De 
THyoscine et de la Daturine. 



NA R CO TICS—HYOSC YAM US. 



103 



United States. It grows to the height of about two feet, with large 
sinuated, pale-green leaves, and flowers of a straw-yellow color. 
The whole plant has narcotic properties ; but the leaves only are 
official. They should be gathered from plants of the second year's 
growth when in flower. 

Chemical Constituents. — The active properties of the plant 
depend upon two alkaloids, one crystallizable, termed hyoscy amine 
(C 17 H 23 N0 3 ), isomeric with atropine ; the other an amorphous, brown 
liquid, to which Ladenburg* has given the name of hyoscine, and 
which, though isomeric with hyoscyamine, differs from it very mate- 
rially. Hyoscyamine can be split into tropic acid and tropine, hyos- 
cine into tropic acid and pseudotropina? ; and both alkaloids unite 
with acids to form salts. 

Effects and Uses. — The effects of henbane on the system 

Fig 8. 




HYOSCYAMUS NIGER. 



much resemble those of belladonna. They differ from those of 
opium in their comparatively /*?<?£/<? hypnotic effect, and in their relax- 



* Deutsch Chemisch. Gesellschaft, 1880-81. 



104 MATERIA MEDIC A AND THERAPEUTICS. 

ing influence on the bowels. In large doses it causes dilatation of 
the pupil, delirium, loss of vision, and, generally, sleep. Hyoscya- 
mine, when pure, is identical in its action with atropine, and recent 
researches have shown that hyoscine is the hypnotic principle of 
henbane, and that it is antagonized physiologically by pilocarpine 
(A. Sohrt). They are both eliminated by the kidneys.* Hen- 
bane may be used remedially in the same diseases as belladonna 
and stramonium, than which it is, however, less active. It has been 
administered also in insomnia, where opium is objectionable from 
its constipating or nauseating influence, and as an hypnotic to 
children. The extract is frequently added to purgative pills in con- 
stipation, to increase their efficiency and prevent griping. The 
tincture is occasionally of service as a sedative to the bladder in 
acute cystitis. Externally, hyoscyamus is employed in the form of 
cataplasm or fomentation to painful swellings and ulcers, and hyos- 
cyamine sulphate may be used to dilate the pupil, in the same 
manner as belladonna. 

Toxicology. — Dr. White f describes the case of a woman who 
took f3xj of the tincture by mistake for black draught ; she became 
immediately giddy, then delirious, with much dryness of the throat, 
but eventually recovered. In cases of poisoning, the same general 
treatment is to be pursued as for belladonna, from which it cannot 
be distinguished. According to Gnauck % morphine is the best 
antidote. 

Dose of the powder, gr. v-x ; of the abstract, gr. ss-ij. Tincture 
(15 per cent.), dose, f5j. An alcoholic extract (a preparation of un- 
certain strength — dose gr. ij, increased until some effect is produced), 
and a fluid extract (dose gtt. x-xx) are also official. 

Hyoscyaminae Sulphas {Hyoscyamine Sulphate) occurs in the 
form of small, yellowish-white scales or crystals, or a yellowish- 
white powder, deliquescent on exposure to the air, without smell, 
but possessing an acrid, bitter taste. It is very soluble in water and 
alcohol. Hyoscyamine is useful in chorea and various forms of 
tremor, § in the dose of gr. ^ hypodermically. It is highly recom- 



* Arch, fur Experimented Pathol, und Pharmacol., Vol. XXII. R. Robert und A. 
Sohrt ; Arch, de Physiologie Norm, et Pathologique, t. iii, 1870, p. 215. De l'Hyosciamine 
et de la daturine par Oulmont et Laurent. 

f Lancet, July, 1873, p. 8. 

\Arch. de Neurologie, July, 1883. 

I Med. News, Jan., 1886. Da Costa. 



NAR CO TICS—D UB CIS I A. 105 

mended by Brown, * and confirmed by Lermoine, f to quiet the 
violence of and produce tranquil sleep without disagreeable sequelae 
in acute mania, though without curative effect. The dose has been 
variously stated by different authors, due, evidently, to the variable 
purity of the drug; as, however, gr. ¥ V of the pure alkaloid has pro- 
duced violent poisoning, % it is better to begin with gr. jfa, and 
gradually increase the dose until some effect is produced. 

Hyoscine Hydrochlorate (not official) is freely soluble in water, 
and resembles atropine physiologically, but produces a more decided 
hypnotic action and less delirium. Its use is followed by headache 
and malaise, and Gnauck states that it slows the pulse decidedly. 
It is said not to cause dryness of the throat. Topically, gr. ss to 
water foj, it widely dilates the pupil, though, in this respect, it is 
less persistent than atropine. It has been administered in whoop- 
ing-cough and asthma, and Mitchell Bruce § advises it in mania and 
insomnia, to relieve the delirium and restlessness. G. Thompson, || 
Medical Superintendent, Bristol Asylum, has used it successfully, 
gr. 2^0, repeated, to allay excitement and produce sleep in acute and 
recurrent ma?tia ; but more experience with it is required in order 
to determine its range of therapeutical uses. Dose, gr. tV; hypo- 
dermically, gr. T io, both to be cautiously used at first. 

DUBOISIA— DUBOISI^ FOLIA. 

The leaves of the Duboisia myoporoides (Nat. Ord. Solanaceae), 
a tree-like shrub of Australia. They are three to four inches long 
and one inch broad, entire, smooth and lanceolate. An alkaloid, 
duboisine, the salts of which are readily soluble in water, has been 
isolated, isomeric with atropine and resembling it in action. Du- 
boisine, internally, produces almost similar effects to those of atro- 
pine, except that the mental excitement, which it causes is followed 
by stupor. Its effect is best seen on the pupil, w r hich it dilates, no 
matter how exhibited. It differs from atropine in causing more 
rapid dilatation and paralysis of accommodation, both of which are 
more fugitive, and in being less irritating. Its physiological action 
is antagonized by opium and physostigma. The use of duboisine is 



* Brit. Med. Jour., November 25th, 1882. 

f Congres. International de Medecine Mentale, 1889. 
X Lancet, 1879, I > 474- 

# Practitioner, November, 1886, p. 321. 
|| Lancet, February 4th, 1888. 



106 MATERIA MEDIC A AND THERAPEUTICS. 

confined to ocular therapeutics. For ophthalmic purposes gr. ij-iv 
may be dissolved in water, fgj. (On Duboisia, Norris, Ringer, 
Seely, Wecker and Bancroft). 

The Mydriatic Alkaloids of the Solanacese, just described, 
all of which act locally, will be here reconsidered, in order to make 
the statements relating to them the more easily understood ; they are 
atropine, daturine, hyoscy amine, hyoscine and duboisine. It is now 
generally admitted that they are all isomeric, having the formula 
C 17 H 23 N0 3 , and, except hyoscine, are all clearly allied in physio- 
logical action. According to Prof. Wormley, atropine, daturine, 
hyoscyamine and duboisine respond similarly to the bromine and 
Vitali's tests. Hyoscine, found only in Hyoscyamus niger, is dis- 
tinguished by possessing an hypnotic action, and in being an amor- 
phous, brown liquid. Belladonnine is also an isomer of these alka- 
loids, but its effects have not yet been investigated. All possess 
basic properties, and, with acids, unite to form salts readily soluble 
in water; and, lastly, atropine and daturine — including hyoscyamine, 
duboisine and hyoscine — form, with gold, salts that have different 
fusing temperatures, which in a measure, seem to distinguish them 
physically. 

It is owing chiefly to the investigations of Ladenburg that the 
chemical relations of these interesting principles have been elucidated. 

The mydriatics are employed chiefly to dilate the pupil for 
ophthalmic examination, as in the diagnosis of cataract, to prevent 
the iritic adhesions of iritis, and prolapsus iridis in perforating ulcer 
of the cornea, and to paralyze the accommodation in testing for 
astigmatism. 

The Myotic Alkaloids. — These are e serine, pilocarpi7ie, nico- 
tine and muscarine, the alkaloid of the Amanita Muscara, or fly- 
fungus. They differ from their congeners in not being isomeric, and 
belong, except nicotine, to different botanical orders. Their action 
is a local one. The myotics, which have a lesser range of utility 
than the dilators, are used to contract the pupil in photophobia, to 
counteract the effects of the mydriatics, and alternately with them, 
to break up adhesions of the iris. 

CANNABIS AMERICANA— AMERICAN CANNABIS. 
CANNABIS INDICA— INDIAN CANNABIS (FEMALE PLANT). 

Cannabis sativa, or Hemp {Nat, Ord. Urticaceae), is a native of 
Persia, and is cultivated in Europe and in the United States. Nar- 



NARCOTICS— CANNABIS AMERICANA. 



107 



cotic virtues were formerly thought to exist only in the C. Indica, 
or Indian variety of the plant, but recent investigation seems to show 
that the hemp plants raised in the Southern States, as Kentucky, are 
active, and might replace the East Indian drug. 

Gunjali is the dried compressed female flowers ; churrus is an 
impure resinous exudation, while bhang consists of the broken stalks 
and leaves made up with fruits ; it is known as hashish. 

Chemical Constituents. — C. Americana is the C. Sativa grown 
in the Southern United States and collected while flowering ; C. Indica 
is the flowering tops of the female plant of C. sativa grown in the 
East Indies. By evaporating a concentrated alcoholic solution of 

Fig. io. 



Fig. 9. 





CANNABIS SATIVA. 
(Female Flower.) 



CANNABIS SATIVA. 
(Female Plant.) 



the latter, an Extract is obtained (extraction cannabis Indices), which 
is the form usually employed. Extract of hemp is of a dark, olive- 
green color, a fragrant, narcotic odor, and a bitter, acrid taste. It is 
soluble in alcohol and ether, but not in water. The resin, which is 



108 MATERIA MEDICA AND THERAPEUTICS. 

the active principle (Egasse),* has received the name of cannabin. A 
volatile oil has been isolated, decomposable into cannabene and can- 
nab ene hydride. Several alkaloids, it is claimed, have been discovered 
in small amounts, of which the principal are cannabinine and ietano- 
cannabine, the latter so named because it possesses tetanizing effects 
similar to strychnine. According to Jahns.f the only alkaloid exist- 
ing in C. Indica is choline, and the principles termed cannabinine 
and tetanocannabine are simply impure choline. 

Aids. — Liquors, wines, cocaine and ether enhance its cerebral 
effects. 

Physiological Effects. — Indian hemp is without local action. 
Nervous system : in medicinal doses it exerts a peculiar exhilarating 
effect upon the brain, the mental excitement induced by it being of 
an agreeable kind, and in this condition ideas flow readily, and con- 
ception of time is lost. Not infrequently the delirium and cerebral 
excitement induced by hemp causes the individual, particularly the 
Hindoostanis, to do deeds of violence, but it does not act upon all 
alike. A prominent symptom after a fu.ll dose is a sense of weight 
about the extremities, accompanied by a loss of muscular power, 
and often a cataleptic state; there is also cutaneous anaesthesia. 
Sleep follows the intoxicating effects of hemp, and the individual on 
awakening is unconscious of what has happened, but suffers from 
depression. It has no action upon respiration, circulation or the 
secretions, but is said to increase the appetite, and aphrodisiac 
properties have been attributed to it. It is unknown how it is elimi- 
nated. Though lethal doses of hemp have produced alarming 
symptoms, there are no recorded fatal cases. 

Medicinal Uses. — Indian hemp is not much used nowadays 
except in asylum practice. It has, however, been employed with 
success in chorea and hysteria ; as a cerebral stimulant in melancholia 
and insanity; \ to relieve the pain of dysmenorrhea^ especially when 
dependent on uterine fibroids, and for this end the extract (gr. y 2 ) 
or tincture (TIX v) may be administered ; and occasionally as an ano- 
dyne in neuralgia. In acute dysentery the tincture TTL xv t. d. after, 
meals is recommended (Rennie) ; § and TTL v-x repeated, is very use- 



* Bull. Gen. de Therap., 1890, t. 118 
f Arch, der Pharm., 1887, p. 479. 
\Brit. Med. J., 2d vol., 1891, p. 12. 
§ Indian Med. Gazette, Dec, 1886. 



NA R CO TICS—HUMUL US. 



109 



ful in dyspeptic diarr/uva, accompanied by defective action of the 
liver, in which the stools follow shortly after meals ; and in the 
anorexia succeeding the prolonged fevers.* It has also been given 
with advantage as an hypnotic in both mania and mania-a-potu. 
Dose, gr. ss-ij or more. A tincture (20 per cent, dose TTLv-xxx), and 
a fluid extract (extractuvi cannabis Indicce fluiduni) are also official; 
dose, ulj-xv. As various samples of cannabis differ much in strength, 
it is better, when first using a new one to begin with the minimum 
dose, to avoid unpleasant effects. 

HUMULUS— HOPS. 

Hops are the strobiles of Humulus Lupulus, or Hop-vine 
[Nat. Ord. Urticaceae), a climbing vine, indigenous in Europe, and 
probably also in North America, with serrated, rough leaves and 
greenish-yellow flowers. The medicinal portion is the fruit, or 

Fig. 11. 




HOPS, STROBILES. 

strobiles, which are also largely employed in the preparation of 
malt-liquors, and are known as hops. Near their base are two 
small, round, dark seeds, covered with aromatic glands or grains, 
which are the active portion of the hops, and are termed lupulin. 
They are separated by threshing, rubbing and sifting the scales, and 
constitute from a sixth to one-tenth part of the weight of hops. 



* The Practitioner, London, Feb., 1888, p 95. J. F. P. McConnell. 



110 MATERIA MEDICA AND THERAPEUTICS, 

Lupulinum (Lupulin) is official, and when fresh is a brownish- 
yellow granular powder which has the aromatic odor and bitter taste 
of hops. Microscopically it consists of two hemispheres; the lower 
somewhat conical, the upper top-shaped, and both reticulated; 
within these is found a yellowish substance resembling vegetable 
pollen. Lupulin is slightly soluble in water and is composed of a 
volatile oil, a bitter principle termed lupulite, resin, tannic acid and 
other matters. The scaly bracts contain a small portion of lupu- 
linic matter. 

Effects and Uses.— Hops are tonic and feebly narcotic. The 
narcotic properties probably reside in the volatile oil, and the tonic 
properties in the bitter-principle. They are said, also, -to possess 
anaphrodisiac and astringent virtues, and sometimes prove diuretic. 
The odorous emanation is employed as an hypnotic by means of 
the hop-pillow. Internally, they are given to relieve insomnia, and 
prevent chordee (in form of lupulin), and are also employed for their 
stomachic and tonic effect. The combination of tonic and hypnotic 
virtues renders hops an excellent remedy in mild forms of mania-a- 
potu. Topically, they are employed in the form of fomentation or 
poultice, in painfid swellings and tumors. As a soothing injection 
in vaginitis, and pruritus vagince, hops oj infused in boiling water 
Oij is recommended by Atthill,* and its efficiency is increased by 
the addition of borax 5j. 

Administration. — Hops are given in the form of infusion (not 
official — dose fgij-iv), and tincture (dose f 3j — iij ). 

The best preparation for internal use is Lupulin, in the dose 
of gr. v-xij, in powder or pills. The Jluid extract of lupulin may 
be used in doses of f3ss-ij. It is best given mixed with a little 
syrup and then largely diluted. The oleo-resin also is official ; 
dose, Tfljj-xxx. 

DULCAMARA. 

The young branches of Solanum Dulcamara, the Woody 
Nightshade, or Bittersweet (Nat. Ord. Solanacese), a European vine, 
naturalized in the United States, possess combined narcotic and di- 
aphoretic properties. The active principles are a poisonous alkaloid 
termed solanine (C 42 H 87 N0 15 ?), which has been found also in S. tu- 
berosum, or common potato, and S. nigrum, or black nightshade, 
and a glucoside, dulcamarin (C^H^O^). 

*" Diseases Peculiar to Women," 7th ed., p. 26. 



ETHEREAL ANAESTHETICS. Ill 

Effects and Uses. — In small doses the most obvious effects of 
bittersweet are an increase in the secretion from the skin and mucous 
surfaces, with some diminution of sensibility. According to Eloy's * 
investigations it is hypnotic, analgesic, mydriatic, and in large doses 
induces vertigo and tinnitus aurium. In excessive doses it is an 
acro-narcotic poison. Its precise use is not obvious, but as an anal- 
gesic it might be serviceable in neuralgia. A fluid extract is offi- 
cial; dose, f5j, largely diluted. 

ORDER II— ETHEREAL ANESTHETICS. 

The term Anaesthetics (from a, non and al'adqcrzt;, sensation), 
properly speaking, includes all agents which diminish sensibility and 
relieve pain. It has, however, been used to denominate a class of 
ethereal remedies which are applied by inhalation, and produce such 
a condition of temporary insensibility as to prevent pain during 
surgical operations and parturition. 

The vapors usually employed to produce anaesthesia are those 
of ether and chloroform. Many other substances have, however, 
lately been introduced as anaesthetics. 

^THER— ETHER. 

Ether is prepared by the distillation of alcohol and sulphuric 
acid, and is afterward rectified by redistillation with solution of 
potassa. For inhalation, however, it is further purified by being 
shaken with water, by which it is freed from alcohol, and this, as 
well as acid contaminations, are afterward removed by the agency 
of calcium chloride and freshly calcined lime. Thus purified, it is 
designated as ^ther Fortior — Stronger Ether. 

Although commonly termed sulphuric ether, in allusion to the 
sulphuric acid used in its preparation, yet ether contains no sul- 
phuric acid. By the action of the acid upon alcohol, ether is formed 
by the substitution of ethyl (C 2 H 5 ) f6r one atom of hydrogen in 
alcohol (C 2 H 5 H O), and is ethyl oxide (C 2 H 5 ) 2 0. 

Ether is a transparent, inflammable, colorless liquid, with a 
strong, fragrant odor and a hot, pungent taste. It wholly evapo- 
rates in the air, so rapidly as to cause a considerable degree of cold ; 
combines with alcohol and chloroform in every proportion, and dis- 
solves in ten times its volume of water. The specific gravity of 

* V Union Medicate, 1886 , p. 745. 



112 MATERIA MEDICA AND THERAPEUTICS. 

pure ether is 0.713, of stro?tger ether (consisting 1 of about 94 per 
cent, of ethyl oxide and about 6 per cent, of alcohol containing a 
little water) 0.725, of ordinary official ether (about 74 per cent, of 
ethyl oxide and about 26 per cent, of alcohol containing a little water) 
0.750. The boiling-point of stronger ether is about 98 F. 

Effects and Uses when Swallowed. — When taken into the 
stomach, ether produces a primary stimulant and secondary narcotic 
effect, the stage of excitement being, however, very transient. Be- 
fore the narcotic effects set in, the heart's beats are increased, the 
face is flushed, and the skin becomes moist. It has long been em- 
ployed as an antispasmodic and anodyne remedy in asthma, angina 
pectoris, hysteria and colic of the stomach and bowels ; and, from its 
combined stimulant and antispasmodic virtues, it has been found 
useful in the latter stages of typhus, attended by subsultus tendinum, 
etc. It has been administered to dissolve hepatic and renal calculi, 
but its solvent virtues, after entering the blood, in this condition lack 
confirmation. In syncope, f5ss or more, it is one of the best stimu- 
lants to restore the heart's action, and may be combined with brandy 
or whiskey. 

As a topical anodyne, ether is a very good application in ner- 
vous headache ; applied by means of an atomizer, it causes local 
anaesthesia ; it has been also used as a cooling lotion in cerebral af- 
fections. The subcutaneous injection of ether is followed by pain and 
inflammation around the site of introduction, which usually subsides 
without suppuration. Thus administered, its systemic effects are 
more quickly produced than per orem. The deep injection is used 
in sciatica and to bring about reaction after hemorrhage, especially 
post-partum, and failure of cardiac action. If evaporation be re- 
pressed, when it is applied locally it acts as a rubefacient, and may 
be employed for counter-irritation. 

Administration. — Dose, f 5ss-j , to be increased when habitu- 
ally used. It may be incorporated with water by rubbing it up 
with spermaceti, in the proportion of gr. ij to ether f5j, or it may 
be given in capsules of gelatin. 

Aids. — Alcohol and chloroform enhance its effect upon the 
brain; by inhalation, chloroform. 

Contraindications. — It should not be exhibited where dis- 
ease of the heart or brain, or serious obstruction of the lungs, exists, 
or when from any cause there is unusual tendency to syncope, and 
precaution should be taken to guard against asphyxia ; but when 



ETHEREAL ANAESTHETICS. 113 

administered with proper care and discrimination, it is attended 
with little or no danger or unpleasant results of any kind. 

Effects when Inhaled. — The first effects of the inhalation 
of ether are a sense of strangulation and cough, from its local 
irritant action. When the vapor is absorbed into the system through 
the pulmonary surface, the nervous functions are successively and pro- 
gressively affected. The mental faculties and volition become first 
impaired; insensibility and unconsciousness rapidly supervene during 
which susceptibility to pain is lost, and the patient lies in a trance-like 
sleep, resembling death. This condition is often preceded by one 
of excitement, during which patients sometimes weep, laugh, moan, 
sing, rave, or present pugnacious manifestations. In the beginning 
of etherization the circulation is accelerated, but it is afterward de- 
pressed. The period of full ether narcosis lasts from five to ten 
minutes, and the patient ordinarily recovers without serious incon- 
venience, although headache, nausea, drowsiness and languor some- 
times ensue for a few hours. Occasionally, congestion of the brain 
or lungs, cataleptic rigidity with prolonged insensibility, and, in fe- 
males, hysterical phenomena, ensue after etherization; but these 
effects are uncommon, and it is believed that death has rarely fol- 
lowed the use of ether when care has been taken to admit atmos- 
pheric air into the lungs along with the ether. During the stage of 
insensibility, convulsive twitches or muscular rigidity are occasion- 
ally noticed; the breathing is somtimes stertorous; the iris becomes 
fixed; the pupils are dilated; the eyeballs are upturned; and the or- 
bicularis palpebrarum does not contract when touched. Insensi- 
bility to pain in some cases takes place before unconsciousness; and 
when patients are recovering from the latter state the mental facul- 
ties are often completely restored, while insensibility to pain con- 
tinues. A brief period of anaesthesia, lasting less than a minute, 
has been noticed to occur before complete insensibility, which may 
be taken advantage of for short operations. It has been shown by 
Flourens and Longet that when ether-narcosis is fully established 
the functions of the nerve-centres are involved in the following order, 
viz., the cerebrum, the sensory centres of the cord, the motor centres 
of the cord, the sensory centres of the medulla oblongata, and lastly, 
the motor centres of the medulla oblongata. The functions which 
continue to act are those presiding over circulation and respiration. 

Since the year 1842, the inhalation of ether — first resorted to 
in our own country by Dr. Crawford W. Long, of Athens, Ga., and 
8 



114 MATERIA MEDICA AND THERAPEUTICS. 

shortly afterward by Morton, a dentist — has been practiced very 
generally in all parts of the world, with the greatest success, for 
the prevention of pain in surgical operations ; and its use has been 
also extended, with the happiest results, to the relief of pain in labor. 

The quantity of ether necessary to effect etherization is about 
two ounces ; and it may be conveniently applied by means of a cone 
of stiff paper, shaped so that its base will fit over the nose and 
mouth of the patient, and into which a napkin or small towel, or 
hollowed-out sponge, is placed ; the sponge should be first soaked 
in warm water, squeezed dry, and saturated with pure ether. It is 
then applied to the mouth and nostrils, the mouth being permitted 
occasionally to receive atmospheric air ; and, if irritability of the 
air-passages occur, this is to be gradually overcome. From three 
to thirty minutes are required to produce insensibility, and its 
occurrence is known by the closure of the eyelids (if they have been 
previously open), failure to respond to questions, and muscular re- 
laxation. The sponge is then to be removed, and may be reapplied 
from time to time if necessary. 

Etherization is less apt to produce nausea if practiced upon an 
empty stomach, and the administration of a little brandy and lauda- 
num promotes its action. 

Toxicology. — The inhalation of ether is not entirely safe, as 
Dr. Lyman * has collected a number of fatal cases (37). To revive 
the respiratory movements when suspended by ether-narcosis, the 
agents that must be employed are artificial respiration, faradization 
of the thoracic muscles, and inversion of the body according to 
Nelaton's plan. 

Medicinal Uses. — Etherization has been resorted to in a vari- 
ety of morbid conditions in which the administration of narcotics and 
antispasmodics has not proven potent enough. It exerts a powerful 
control over the violent types of spasmodic disease, and has been 
prescribed with advantage in hysteria, tetanus, strychnine poisoning, to 
prevent a paroxysm of asthma, chorea, convulsions, puerperal eclamp- 
sia, to alleviate the pain of biliary and nephritic colic, as a relaxant in 
the diagnosis and reduction of dislocations, in the examination and 
setting of 'fractures, for taxis in hernia, the breaking up of adhesions, 
and in the diagnosis of malingering. The extent to which etheriza- 
tion should be pushed, varies of course, with the nature of the dis- 
ease and the acuteness of the pain. During the passage of calculi, 

*" Artificial Anaesthesia, etc.," 1881, p. 289. 



ETHEREAL ANAESTHETICS. 115 

for instance, it should be carried to the point of relieving the pain, 
while in dislocations complete anaesthesia is necessary. 

To relieve the pain of labor, complete narcosis should not be 
produced, as cessation of uterine contractions and loss of uterine 
retractility may result, leading to a delay in the delivery, retention 
of the placenta, and even post-partum hemorrhage. It should only 
be administered during the pains and intermitted between them, 
thus abating the suffering without abolishing voluntary efforts at 
expulsion. 

Instrumental or manual interference with labor may render 
complete anaesthesia necessary, or it may be desirable temporarily 
to aid in the relaxation of a rigid cervix, or to prevent the woman 
from bearing down when the perinaeum is endangered by a too 
rapid delivery. 

Local anaesthesia and congelation may be produced through 
the agency of the ether spray applied to a part by the atomizer. 

CHLOROFORMUM— CHLOROFORM. 

Chloroform is usually obtained from the distillation of alcohol 
with chlorinated lime, and for medicinal use, 

Commercial Chloroform (Chloroformum Venale) (containing at 
least 98 per cent, of chloroform) is purified by agitation with one- 
fifth of its weight of sulphuric acid, which destroys the contamina- 
tion of chlorinated pyrogenous oil ; and the sulphurous acid formed 
and the water present are afterward removed by means of a watery 
solution of sodium carbonate and of stronger alcohol and lime. 
The purest chloroform for internal use is now made from chloral 
hydrate. Recently, (1891), it has been found possible to purify 
chloroform by congelation with intense cold. 

Purified Chloroform (Chloroformum Purificatuni) is a colorless, 
volatile liquid, of a bland, ethereal odor and a hot, aromatic, sac- 
charine taste. It is not inflammable, is slightly soluble in water and 
freely soluble in alcohol and ether. It has extensive solvent powers, 
dissolving camphor, the fixed and volatile oils, most resins and fats, 
iodine, bromine and the organic alkaloids. The purest chloroform 
has a specific gravity of 1.5022. Official chloroform has a specific 
gravity of 1. 485-1. 490 when it contains a little alcohol; and as 
usually found its specific gravity is about 1.475, when it contains 
more alcohol, and is less apt to become acid. The boiling point of 
pure alcohol is 142 F. It is chemically classed with the triatomic 



116 MATERIA MEDICA AND THERAPEUTICS. 

haloid ethers and is methenyl chloride (CHC1 3 ). Chloroform is 
sometimes contaminated with chlorinated pyrogenous oil (a very 
injurious impurity); this may be detected and removed by strong 
sulphuric acid, which gives the chloroform a color varying from 
yellowish to reddish brown, according to the amount of impurity. 
The most delicate test for the presence of alcohol is iron binitro- 
sulphuret, which, when agitated with chloroform, will produce a 
brown tint if alcohol be present. Ag.N0 3 will detect the chlorides. 

Aids. — (See ether.) Locally by rubefacients, as camphor. 

Contraindications. — Chloroform, like ether, should not be 
administered by inhalation to persons suffering from any serious 
disease of the brain or heart (especially fatty degeneration), or where 
any serious obstruction to the circulation exists. 

Physiological Effects. — The effects of chloroform by the 
stomach on the system are analogous to those of ether, but much 
more rapid and powerful. When inhaled, in the dose of a nuidrachm 
or more, it rapidly induces anaesthetic sleep, with a great relaxation 
of the muscles, gradual lowering of the blood-pressure, and the most 
complete insensibility to painful agents. The period at which in- 
sensibility occurs varies from fifteen seconds to two minutes, and it 
continues usually between five and ten minutes, and may be pro- 
longed considerably by renewal of the inhalation. The patient 
usually recovers without recollection of what has occurred during 
the state of insensibility, and with few or no uncomfortable sequelae. 
Sensibility to pain is often very much obliterated even before con- 
sciousness is lost. 

Topically applied, and when its evaporation is prevented, chlo- 
roform acts as an irritant, and soon vesicates the skin — powerfully 
diminishing painful impressions during its application. 

Toxicology. — The administration of chloroform has in many 
cases been attended with fatal syncope. (Lyman* has collected 393 
cases), due to alleged heart-paralysis. An elaborate investigation, 
however, made upon dogs as to its toxic action, conducted by the Hy- 
derabad Chloroform Commission, f seems to negative this statement. 
They found " that chloroform does not paralyze the heart but kills by 
stopping respiration." But this conclusion is not in accordance 
with the results reached by Wood and Hare, j who found in their 

*" Artificial Anaesthesia, etc.," 1881, p. 136. 
-\ Lancet, London, Jan. 18, 1890. 
% Medical News, Feb. 22, 1890. 



ETHEREAL ANAESTHETICS. 117 

investigations that the heart ceased beating before respiration 
stopped. Be this as it may, death has ordinarily occurred with 
such rapidity as to render remedial interference almost unavailable ; 
but at the slightest approach of poisonous symptoms the patient must 
be placed in the recumbent position, the head lowered and the tongue 
drawn forward with catch-forceps, cold affusions applied, and, above 
all, artificial respiration , together with electro-magnetism to the re- 
spiratory muscles, the inverted position of Nelaton, and injections 
subcutaneously of ether or ammonia water, should be resorted to. 

Medicinal Uses. — Chloroform is prescribed by the stomach 
as an anodyne and antispasmodic, in all cases to which ether is ap- 
plicable, and has the advantage of a more agreeable taste. It has 
been found particularly useful to relieve the pain and vomiting of 
cancer of the stomach and also in intestinal colic and in cholera. For 
diarrhoea and colic a good formula is — 3^ Spiritus chloroformi, f5ss ; 
tincturae capsici, Tttv-x ; morphinae sulphatis, gr. J^ ; aquae, foss. 
M. S. — One dose. Externally, it is used as a topical anodyne. 
The editor has used the deep injection of chloroform, Ttlx-xx in 
sciatica, with good results — the injection being made over the nerve. 

Administration. — Dose, from Ulxv to f5ss, in sweetened water 
or mucilage ; to be repeated. As an antineuralgic liniment, f5j to 
f oij of camphor liniment ; or as a rubefacient and anodyne, undilu- 
ted, on linen, covered with oiled silk, to prevent evaporation. As 
a wash or gargle, f5j or ij to water Oj. 

The introduction of chloroform as an anaesthetic — which prop- 
erty was first discovered by Sir James_ Y. Simpson, took place 
shortly after that of ether ; and from its greater intensity of action, 
its freedom from irritating effect on the bronchial mucous membrane, 
its more agreeable odor, and its non-inflammability, it has been ex- 
tensively used, particularly in Great Britain, to the exclusion of ether. 
A very considerable number of fatal cases have, however, occurred 
from the inhalation of this agent, where its administration did not 
appear in any way contraindicated ; and it cannot be considered a 
perfectly safe remedy. It is employed as an anaesthetic, anodyne and 
antispasmodic, to fulfill the indications to which ether is applicable. 
In labor chloroform should not be given until complete dilatation of 
the os has taken place, the head descending and the pains propul- 
sive.* It should be inhaled only when the pains come on, and there 

*Playfair, 5th ed., vol. I, p. 353. 



118 MATERIA MEDICA AND THERAPEUTICS. 

is no doubt that its entire safety in obstetric practice is due to the 
intermittent plan of administering it. Its non-inflammability, too, 
in midwifery, should not be lost sight of. By inhalation, when other 
means have failed, it may prove serviceable to control the spasms of 
hydrophobia. It is also used hypodermically ; dose, TTLx-xx. 

The dose for inhalation is a fluidrachm, to be repeated in two 
minutes if anaesthesia be not produced ; and its effects may be re- 
newed from time to time without injury. It may be applied on a 
handkerchief, held near the nose or mouth, care being taken to allow 
a proper admixture of atmospheric air. 

A solution of chloroform in ether has been used in the United 
States, but, from the unequal volatilization of the two liquids, it 
must be difficult to modify their effects by combination. 

Spiritus Chloroformi {Spirit of Chloroform) is a solution . of 
chloroform in alcohol ; a convenient form for internal exhibition. 
Dose, f5j. Serviceable to relieve headache where a mild stimulant 
is indicated. 

Linimentum Chloroformi {Chloroform- Linimeni) is made by 
mixing 40 parts of commercial chloroform with 60 parts of soap- 
liniment. Useful as a stimulating application in chilblain. 

Mistura Chloroformi {Mixture of Chloroform) is made by mix- 
ing purified chloroform (8 parts), in which camphor (2 parts) is 
dissolved, with water (80 parts), by the intervention of fresh yelk of 
egg (10 parts). Dose, f§ss-j.* 

Since the discovery of the anaesthetic properties of ether and 
chloroform, many other substances have been employed for the pur- 
pose of anaesthesia. Of these may be mentioned — 

I. Methylene Bichloride. — This liquid, introduced to the pro- 
fession by Dr. W. B. Richardson in 1867 (known also as dichlo- 
romethane), is most easily procured by the action of nascent hydrogen 



* Under the name of chlorodyne a combination containing chloroform is much used, for 
which the following is a formula: morphine hydrochlorate, 8 grains; oil of peppermint, 16 
minims ; stronger ether, a fluidounce; extract of liquorice, 2^ Troy ounces ; pure chloroform, 
stronger alcohol, and molasses, each 4 fiuidounces ; diluted hydrocyanic acid, 2 fluidounces ; 
syrup, X'jYz fluidounces ; dissolve the morphine and oil in the alcohol, and add the chloro- 
form and ether, mix the liquorice, syrup and molasses, shake the two mixtures, and add the 
hydrocyanic acid ; dose, 5 to 10 minims, the vial to be well shaken. An analysis of Brown's 
chlorodyne made in 1892 shows it to contain 15 per cent, of chloroform and 2 grains of 
morphia per ounce. 

Numerous other formulae for chlorodyne have been published, but the above more nearly 
resembles the original preparation sold under this name. This remedy is often very service- 
able in cholera morbus and infantum, and acute diarrhcea. 



ETHEREAL ANAESTHETICS. 119 

(developed from zinc, water, and sulphuric acid) upon chloroform. 
Its composition is CH 2 C1 2 . It is a colorless fluid, having a pleasant 
ethereal odor like that of chloroform, boils at 88° F., has sp. gr. 1.34, 
and mixes with ether and chloroform in all proportions. The vapor 
of methylene bichloride is pronounced by Mr. Spencer Wells to be 
the best known anaesthetic. Given properly diluted with air, accord- 
ing to his method (in an experience of more than a thousand cases), 
it has proved of uniform certainty and rapidity of effect, and free 
from any dangerous symptoms. It is used in about the same dose 
as chloroform, but has not been much employed in the United States. 
Nine fatal cases from its employment are recorded.* 

II. Methylic Ether, made by digesting methylic alcohol with 
strong sulphuric acid, is a gaseous substance, lately employed. Under 
the name of methyl-ethylic ether, it has been used, dissolved in ethylic 
ether, and is said to produce rapid anaesthesia, without spasm, syn- 
cope, or asphyxia during inhalation, or subsequent nausea. One or 
two drachms may be introduced into a bag-inhaler, and the gas is 
volatilized by means of a hand-bellows. 

III. Nitrous Oxide Gas, N 2 0, was the substance by which 
anaesthesia was in the first instance produced, in the hands of Mr. 
Horace Wells, a dentist of Hartford, Connecticut. It is made by 
the decomposition of ammonium nitrate by heat. It is a colorless, 
respirable gas, absorbable by water, and the solution, like the gas 
itself, has a faint, agreeable odor and sweet taste. This gas is both 
a pleasant and efficient anaesthetic, more rapid and at the same time 
more transitory in its action than either ether or chloroform, and 
almost free from disagreeable or serious consequences. Lymanf 
has collected only four fatal cases which can be fairly attributed to 
nitrous oxide gas. During unconsciousness it causes considerable 
mental excitement, shown in various ways, as laughing, crying, etc., 
and lividity of the face. Buxton,J who has investigated its action, 
sums it up as follows : By trephining a dog and administering 
nitrous oxide gas, he observed the normal vermilion hue of the 
superficies change to purple, stasis within the vessels, and the brain 
substance to increase in size ; the cord viewed similarly was found 
also augmented in volume, so that some cerebro-spinal fluid was 



* Brit. Med. Jour n., 1883, ii, 104. 
f" Artificial Anaesthesia, etc ," 1881. 

\ Transactions of the Odontological Society of Great Britain, 1886-7, p. 90. On the 
Physiological Action of Nitrous Oxide Gas. 



120 MATERIA MEDICA AND THERAPEUTICS. 

squeezed out. In both experiments the results obtained were the 
reverse of those induced by asphyxia, to which nitrous oxide uncon- 
sciousness has been attributed. Buxton considers its anaesthetic 
action due to its own inherent sedative virtues, and as far as asphyxia 
is concerned seems to have proved his position. The heart's action 
and blood-pressure are not much altered. The respiratory move- 
ments are primarily quickened, then slowed, and finally extinguished 
— probably by paralysis of the centre. The heart continues to beat 
for a short time after the stoppage of respiration. Certain peculiar 
phenomena are occasionally encountered, as muscular rigidity fol- 
lowed by flaccidity, loss of the superficial reflexes, persistence of 
knee-jerk, and less frequently involuntary evacuation of the bladder 
and rectum, and excitation of the sexual organs. It is well adapted 
to employment in the extraction of teeth, or, in short minor surgical 
operations, but its effects are too transient for the anaesthesia required 
in protracted operations. The amount necessary to produce anaes- 
thesia (one or two gallons), as well as the complicated apparatus 
required for its administration, constitute also an objection to its 
general use. It is best administered from an India-rubber bag, con- 
taining about eight gallons of the gas, furnished with a mouth-piece 
with two valves, one of which is designed for the throwing out of 
the respired gas. 

IV. Ethyl Bromide, (C 2 H 5 Br) is an anaesthetic which a few 
years ago bid fair to supersede ether and chloroform, but the occur- 
rence of several fatal cases under its administration led to the abandon- 
ment of its use, and it is now seldom resorted to. Ott* states that 
it destroys life either when inhaled or administered subcutaneously> 
by a toxic action on the respiratory centre. 

For the relief of pain during minor surgical operations, as the 
opening of abscesses or the extirpation of small tumors, local ances- 
thesia may be resorted to. This consists in congelation of the part 
by means of a freezing mixture (as ice and salt, which, when applied 
for three minutes to the integument, causes a thorough deadening 
of sensation in the superficial structures) ; or in spraying the part 
with some substance, as ether or ethyl bromide, which by its rapid 
evaporation produces the same effect ; or the same purpose may be 
effected by the application of remedies like cocaine (q. v.), or carbolic 



Bromide of Ethyl ; its Toxicological Action." I. Ott, pamphlet. 



ANTISPASMODICS. 121 

acid (q. v.), which depress the sensory nerves of the part to which 
they are applied, and thus deaden sensation. 

ORDER III.— ANTISPASMODICS. 

Antispasmodics are medicines that allay irregular nervous action. 
Their effects upon the economy in a state of health are not very 
decided, and are limited to a slight stimulation of the circulation 
and exhilaration of the mental faculties. Their proper influence is, 
however, strikingly shown in certain deranged conditions of the 
nervous system, particularly those forms of spasm which depend 
upon idiopathic or primary nervous disorder, and are known under 
the designation of hysteria. They are also useful in many varieties 
of mental disturbance, as wakefulness, hypochondriasis, and even 
insanity, and are often preferable to narcotics in the treatment of 
these cases, from their comparative freedom of action on the brain. 
They are all distinguished by a powerful odor. 

ASAFCETIDA.-ASAFETIDA. 

Asafetida is a gum-resin obtained from the root of Ferula Nar- 
thex and Ferula Scorodosma [Nat. Ord. Umbelliferae), and is de- 
rived from Afghanistan. Though these are the sources given by 
the U. S. P., yet its exact commercial derivation has not yet been 
proven.* The plant has a long tapering root, the size of a man's 
leg, and an erect stem, from six to nine feet in height, rising from 
the midst of the leaves. The drug is obtained from incisions into 
the root, or by taking successive slices of it. The exuded juice is 
scraped off, hardened in the sun, and afterward packed for exporta- 
tion. It occurs in masses of varying size, consistence, and color, 
but is usually whitish, intermixed with darker spots, and becomes 
reddish, and finally brown, by exposure to the air. It is sometimes 
soft and adhesive, at other times hard and brittle, and is not readily 
powdered except at a low temperature. It breaks with a waxy 
lustre, and the best samples appear to be composed of irregularly- 
shaped tears. Its taste is unpleasant, bitter, and acrid ; its odor 
powerful, alliaceous, and fetid. 

Asafetida is a gum-resin united to an alliaceous volatile oil. The 
gum is dissolved by water, and the mucilage thus formed suspends 
the resin and volatile oil. The resin and volatile oil are soluble in 



Pharmacographia, 2d ed., p. 314. 



122 MATERIA MEDICA AND THERAPEUTICS. 

alcohol; but the tincture becomes milky on the addition of water, 
owing to the separation of the resin. The resin contains ferulaic 
acid (C 10 H 10 O 4 ) and umbelliferon (C 9 H 6 3 ), and, when fused with 
potassa, yields resorcin. 

Physiological Effects. — Asafetida, when taken into the stom- 
ach, produces a local stimulant and carminative effect. After ab- 
sorption, it proves a moderate excitant and exhilarant, and exerts a 
marked antispasmodic influence upon morbid conditions of the 
nervous system. Large doses cause nausea and vomiting. It also 
stimulates the mucous secretions generally, and increases the per- 
istaltic action of the bowels, inducing soft, offensive stools. Its 
volatile oil is absorbed, and the odorous principle is recognized in 
the secretions, especially in the perspiration. 

Medicinal Uses. — No medicine used to be more highly es- 
teemed as an antispasmodic than asafetida, but it is now not often 
employed, because more efficacious and less disagreeable remedies 
have superseded it. It is resorted to in the various forms of hys- 
teria, and is valuable in relieving the mental depression which con- 
stitutes one of the protean types of this disorder. In certain affec- 
tions of the abdominal viscera, as flatulent colic and costiveness y 
asafetida is often useful as an atispasmodic and laxative enema. In 
flatulent colic occurring in children, the mixture in doses of f5j will 
generally give speedy relief. In tympanites, especially in hysteri- 
cal patients, or when accompanying constipation, nothing proves 
more serviceable than enemata of the mixture, or suppositories 
(containing the equivalent of TTLxl of the tincture). Enemata of the 
mixture have been used for the tympanites occurring in typhoid 
fever, but from the laxative effects of asafetida, turpentine is to be 
preferred in these cases. 

Notwithstanding its disagreeable odor, this drug is largely 
used as a condiment in Asia ; and even in the refined cookery of 
Europe its flavor is admired. Some persons take it habitually for 
its exhilarant effects ; and, when used as a medicine, it generally 
becomes acceptable. 

Administration. — Dose, gr. v to xx, in gelatin-capsules. It 
is most frequently given in the form of mixture (mistura asafcetidce, 
— 4 parts to water ioo parts) — dose f^ss-j, repeated, or as an 
enema, foij-iv. The mixture, from its whiteness and opacity, is 
sometimes called lac asafcetidce, or milk of asafetida. Pills of asa- 
fetida are official, each pill containing gr. iij of the gum-resin. The 



ANTISPASMODICS. 123 

tincture (20 parts to 100 of the tincture — dose, f5j) is a good prepa- 
ration, where the alcohol is not objectionable. A plaster is used 
externally in wliooping-cough and bronclntis ; it contains galbanum. 
Pills of aloes and asafetida and mixture of magnesia and asafetida 
(Dewees' carminative) are also official. The latter contains mag- 
nesium carbonate (5 parts), tincture of asafetida (7 parts), tincture 
of opium (1 part), sugar (10 parts), and distilled water (q. s. to 
make 100 parts) ; dose, f5j-iv. 

GALBANUM. 

Galbanum is a gum-resin obtained from _ Ferula galbaniflua 
and other species of Ferula {Nat. Ord. Umbelliferae) which grows 
in Persia. It is met with in the form of tears, or more commonly 
in lumps, of a brownish color, and has a peculiar balsamic odor 
and a hot, bitter, acrid taste. It is a gum-resin united to a volatile 
oil. From the resin are obtained umbelliferon and resorcin. Its 
effects are similar to those of asafetida, but less active ; and it is 
chiefly employed externally, for its rubefacient properties, as a stim- 
ulant. The compound pills of galbanum are used for antispasmodic 
and emmenagogue purposes ; they contain galbanum, myrrh and 
asafetida, with a little syrup — dose, 3 to 5 pills. Galbanum forms 
the basis of the galbanum- pi aster, which contains galbanum, tur- 
pentine, Burgundy pitch, and lead-plaster. 

AMMONIACUM— AMMONIAC. 

This is a spontaneous gum-resinous exudation obtained from 
Dorema ammoniacum [Nat. Ord. Umbelliferae), a plant of Persia. 
It comes in tears or lumps, of an irregular shape, yellowish on the 
outside, whitish within, is moderately hard and brittle, and has an 
unpleasant, bitter, and rather acrid taste, with a peculiar smell, 
somewhat like that of galbanum. It is a gum-resin, with a little 
volatile oil, the latter free from sulphur. Resorcin, but no umbelli- 
feron, is obtained from the resin. Its effects are similar to those of 
asafetida ; but it is seldom used except as an antispasmodic-expec- 
torant in chronic bronchitis. Dose, gr. x to xxx. A mixture, 
4 parts to water 100 parts, and plaster are official. The plaster is 
made with ammoniac and acetic acid. A plaster of ammoniac with 
mercury is also official. 

CAMPHORA— CAMPHOR. 

Camphor is a stearopten derived from Camphora Cinnamo- 
mum, the Camphor- Laurel {Nat. Ord. Lauraceae), a large evergreen 



124 MATERIA MEDIC A AND THERAPELTICS. 

tree of China, Japan, and the island of Formosa. All parts of the 
tree are strongly impregnated with camphor, which is obtained 
from the chips of the roots and branches by subliming them with 
water and collecting the condensed camphor in pots. In this state 
it is known in commerce as crude camphor, and consists of dirty- 
grayish grains adhering in crumbling masses. Japan camphor, 
(called also Dutch camphor, because introduced to commerce from 
Nagasaki by the Dutch colonists), has a pinkish color and is purer 
though coarser than the China camphor. The crude camphor, as 
imported from Canton and Japan, is not found in the shops until it 
is purified by resublimation with quick-lime, when it is termed 
refined camphor. This occurs in large hemispherical* or convex- 
concave cakes perforated in the middle. It is solid at ordinary 
temperatures, soft and somewhat tough, but may be readily pow- 
dered by the addition of a few drops of alcohol, chloroform, ether, 
or equal weight of sugar. It is translucent, has a strong, fragrant 
odor, and an aromatic, bitter, afterward cooling taste. . It is vola- 
tile, highly inflammable, lighter than water, and very slightly solu- 
ble in it, but soluble in alcohol, ether, chloroform, oils and acids. 

A valuable camphor* is known in the East, which is found in 
a concrete state in the cavities and fissures of the trunk of Dryo- 
balanops Camphora (Nat. Ord. Dipterocarpaceae), a tree of Borneo 
and Sumatra. By tapping the tree, or as a natural exudation, a 
camphor-oil is obtained (DeVriese loc, sit.), which must not be 
confounded with that of the laurel-camphor. 

Camphor is C 10 H 16 O, and is chemically nearly related to the 
terpenes (turpentine). It forms substitution compounds with bro- 
mine, chlorine, and iodine, and yields an oil called oil of camphor > 
which drains away from the vats in the preparation of crude cam- 
phor. By passing hydrochloric acid into oil of turpentine, a sub- 
stance is obtained called artificial camphor. Camphor heated with 
zinc chloride yields cymol (C 10 H 14 ), and with nitric acid, camphoric 
acid (C 10 H 16 O 4 ), and camphoronic acid (C 9 H 12 5 ), the last two being 
oxidation products of camphor 

Incompatibles. — Water precipitates camphor from the spirit 
of camphor. 

Aids. — The cerebral excitants, as cocaine, cannabis Indica, 
ether, chloroform and alcohol. 



* Jotirn. of Pharmacy, xii, p. 22. On the Camphor of Sumatra; De Vriese. 



ANTISPASMODICS. 125 

Physiological Effects. — The topical action of camphor is 
rubefacient and irrritant. After its absorption, its effects, in small 
doses, are moderately stimulant, exhilarant, and anodyne. In large 
doses, it causes considerable disorder of the cerebro- spinal system, 
depression of the circulation, and diaphoresis ; and in excessive 
quantity it acts as a narcoto-irritant, occasioning burning heat in 
the stomach, violent cerebral convulsions, and maniacal delirium. 
No deaths from camphor, however, have been reported in healthy 
adults. In small doses, gr. v, owing no doubt to the stimulation of 
the circulation, it is aphrodisiac ; in full doses, gr. xx, anaphrodisiac. 
Camphor is eliminated by the breath, skin, and urine, and it has 
been detected in the blood. In cases of poisoning, after evacuating 
the stomach, demulcents, opium and wine are to be administered. 

Medicinal Uses. — From its combined antispasmodic and dia- 
phoretic powers, camphor is a valuable remedy in the treatment of 
acute dysentery and in cholera, and is much employed in these dis- 
eases, either in combination with opium or as a substitute for the 
latter; 3^ Spiritus camphorae, tincturae opii, aa TTLx. M. S. — Every 
I or 2 hours, in a little water. In the early stages of summer diar- 
rhoea it is also frequently prescribed, and for this purpose the spirit 
may be given gtt. x-xx, and repeated p. r. n. with paregoric. As a 
diaphoretic stimulant and antispasmodic, it is useful in the low stages 
of typhoid and typhus fevers, and in typhoid conditions of the system 
generally. In many forms of mental disorder it calms irritability, 
relieves despondency, and induces sleep. And it is useful as an 
anodyne in allaying irritation or pain of the genito-urinary organs, 
as in dysmenoj'rhcea, uterine after-pains, strangury, and nymphomania. 
In chordee large doses are required — gr. x-xx. Milton * considers 
f5ss-j of the spirit in water before retiring the best remedy for this 
complaint. He repeats the dose every time the patient awakes with 
chordee. On account of its pungency the administration of the 
fluid preparations of camphor is objectionable. Bumstead f gave it 
in pill, gr. iij-yj, at bed-hour, combined with opium. Camphoric 
acid | (5/4 in 24 hours) has recently been shown to possess anti- 
sudorific properties against the sweating of phthisis. Externally , 
camphor is employed as an anodyne in rheumatism, and as a dis- 



* " On the Pathology and Treatment of Gonorrhoea,' etc., 1887, P- x 67. 
f " Pathol, and Treat, of Venereal Diseases," 1883, p. 91. 
j Bull. Gen. de Therap., 1891, t. i. p. 14. 



126 MATERIA MEDIC A AND THERAPEUTICS. 

cutient in chronic inflammatory affections. Powdered camphor, 
sniffed into the nostrils, is a good remedy in acute nasal catarrh, 
coryza and influenza, or it may be volatilized in hot water and its 
fumes inhaled through a paper-funnel ; it also enters into the compo- 
sition of tooth-powders. 

Administration. — The medium dose in substance is gr. v-x; 
but it may vary from gr. j to xx. It is best given in emulsion made 
by rubbing up the camphor with loaf-sugar, gum-arabic, myrrh and 
water. The form of pill is objectionable, from the difficulty with 
which it is dissolved in the gastric liquors. 

Aqua Camphorae {Camphor -Water). Dose, f5j (containing 
about gr. ij) to f§ij or iij. The spirit is used chiefly as an embroca- 
tion, but it may be given internally on a lump of sugar, where the 
action of alcohol is not objectionable, in the dose of gtt. v to f5j — 
a serviceable remedy diluted with water to relieve headache where a 
gentle stimulant is indicated; and to check hiccough. 

Hope's Camphor Mixture consists of camphor-water, foviij ; 
nitrous acid, f5j ; laudanum, gtt. xxv ;. dose, f§ss, repeated. This 
preparation is an efficient remedy in the treatment of acute diarrhoea 
and dyse?itery. It is not official. 

Linimentum Camphorae {Camphor-Liniment) consists of camphor 
(20 parts) dissolved in cotton-seed oil (80 parts) ; a mild embro- 
cation. 

Ceratum Camphorae {Camphor- Cerate) is made by mixing cam- 
phor-liniment (3 parts) with olive-oil (12 parts), and incorporating 
the mixture with cerate (85 parts). 

Linimentum Saponis {Soap- Liniment) is made by digesting soap 
and camphor with oil of rosemary in alcohol and water. It is a 
yellow oleaginous liquid, and is used as an anodyne and gentle 
rubefacient application in gouty and rheumatic pains, chilblain, sprains, 
bruises, lumbago and myalgia. It is useful to cleanse the skin in 
stearrhoea, and should be followed by an application of lime-water. 
It is also frequently combined with other liniments, as those ot 
chloroform or ammonia. 

Camphora Monobromata {Monobromated Camphor) is pre- 
pared by letting fall a stream of bromine upon powdered cam- 
phor till the latter is liquefied, then boiling the mixture in a 
water-bath, and afterward dissolving in alcohol and crystallizing. 
It occurs in long, colorless, acicular crystals (C 10 H 15 OBr), having 
an odor of camphor and turpentine and a slightly bitter taste, 



ANTISPASMODICS. 127 

insoluble in water, but soluble in alcohol, the fixed and volatile 
oils, ether, carbon bisulphide, and chloroform. It is a substitution 
compound, one atom of bromine taking the place of an atom of 
hydrogen in laurel-camphor. It has been used in delirium tre- 
mens and hysteria; dose for an adult, gr. v, repeated. 

VALERIANA— VALERIAN. 

Valeriana officinalis, or Wild Valerian (Nat. Ord. Valerianaceae), 
is a perennial European plant growing to the height of three or 
four feet. The rhizome and rootlets are the portions used, and 
consist of numerous brown, slender, brittle fibres, attached to a 
rough, yellowish-brown, tuberculated head. When powdered, it 
is yellowish-gray. It has a peculiar, powerful odor, of which 
cats are fond, and a bitterish, sub-acrid, aromatic taste. Water 
and alcohol extract its virtues, which depend on the presence of 
a volatile oil, and a colorless volatile acid, called valerianic, may be 
separated either from the oil or root. 

Effects and Uses. — The effect of valerian on the nervous sys- 
tem is not constant, for it is sometimes excitant, and again calm- 
ing. The hypodermic injection of valerian oil reduces the reflex 
excitability of the spinal cord, and antagonizes in frogs the tetanic 
spasms of strychnine. In medicinal doses, valerian improves di- 
gestion and appetite, decreasing the urinary flow and excretion 
of urea (Yvon *), hence it may prove serviceable in diabetes insi- 
pidus. Large doses occasion eructations, colic and diarrhoea, ex- 
citement of the circulation, diaphoresis, and increased urinary flow. 
It is much used as a nervous excitant and antispasmodic in the 
various forms of hysteria and melancholia, to control the active 
manifestations of which it may be prescribed with asafetida; ^ 
Tincturae Valerianae ammoniatae, tincturae asafcetidae, aa f5j. M. S. 
— One dose. Moral influence, however, in this unfortunate con- 
dition is mostly superior to medicine. Occasionally it is given 
in hypochondriasis and in nervous headache. 

Administration. — Dose of the powder, from 5ss-jss, three or 
four times a day; of the abstract, gr. v-xv; of the tincture (20 per 
cent, in diluted alcohol), f5j ; of the ammoniated tincture (20 per 
cent, in aromatic spirit of ammonia — an excellent preparation), f5j 
to ij; of the fluid extract, f5j; of the oil, gtt. iv-v, taken dropped on 
sugar. 

*Arch. de Neurol, xix, 1890, p. 229. 



128 MATERIA MEDICA AND THERAPEUTICS, 

Ammonii Valerianas (Ammonium Valerianate). — This salt, 
made by combining valerianic acid with ammonia, occurs in 
snow-white quadrangular plates, of an offensive odor like that 
of valerianic acid, and a sharp, sweetish taste. It deliquesces in 
a moist air, effloresces in a dry one, and is very soluble in both 
water and alcohol. Potassa and the mineral acids decompose it. 
It is much employed as an antineuralgic and antispasmodic in 
neuralgia, nervous headache, hysteria, chorea and epilepsy. Dose, 
gr. ij-viij, given in coated pills; or an elixir, prepared with aro- 
matics,* may be used. 

CYPRIPEDIUM. 

The rhizome and rootlets of Cypripedium pubescens and 
of Cypripedium parviflorum (Nat. Ord. Orchidaceae), common in- 
digenous plants, known under the names of ladies' slipper and 
moccasin-plant, are recognized by the U. S. Pharmacopoeia. 

The dried root'is several inches long, bent, with a small, knotted, 
dark head, and numerous fibres of yellowish-brown color. It con- 
tains a volatile oil, volatile acid, and resin, and has been used as a 
substitute for valerian. Dose of the fluid extract (the only official 
preparation), Tfl.x-xx. The powdered root may be given in doses 
of gr. xv, three times a day. An infusion and tincture are also 
used ; by precipitating the tincture with water, an oleo-resin is ob- 
tained, of which the dose is gr. ss-iij. 

SCUTELLARIA. 

The herb of Scutellaria laterifolia, or Skullcap (Nat. Ord. 
Labiatse), an indigenous perennial herb, found in moist localities, 
growing to the height of one or two feet, containing a crystalline 
bitter glucoside.f is considered by many American practitioners to 
possess valuable antispasmodic properties. A fluid extract is offi- 
cial. S. pilosoa and integrifolia possess a more bitter taste, and have 
been used as tonics. 

The following vegetable substances, used as articles of diet, 
may be ranked also with antispasmodics : — 

I. Thea — Tea (not official), the dried leaves of Thea chinensis 

* Take of ammonium valerianate, gj; fluid extract of vanilla, f Jss; cd. tinct. of 
cardamom, f 3 vj ; curacoa, fgij ; water, f^iv; mix. Dose, a teaspoonful three times 
a day. 

I Am. Journ. Pharm., Nov., 1889. 



ANTISPASMODICS. 129 

{Nat Ord. Ternstromiaceae), an evergreen shrub of China, India and 
Japan, whence the markets of the world are supplied. The most 
important constituents of tea are essential oil (upon which the flavor 
depends), tannic acid, an alkaloid termed theine, discovered by 
Oudry, in 1827 — identical with caffeine, and boheic acid. According 
to Attfield * and others theine or caffeine is the alkaloid of tea, 
mate, guarana and kola- nut. Dr. Mays t found it to be analgesic, 
and he has employed it, gr. xVi, subcutaneously for the relief of 
pain, though his experience was not entirely confirmed by Castle.J 
A strong cup of tea is a good remedy for headache. 

II. Caffea — Coffee (not official) the seed of Coffea arabica 
(iVat. Ord. Rubiaceae), a small tree which is a native of southern 
Arabia and Abyssinia, and is cultivated in various tropical and 
semi-tropical countries. Coffee contains an alkaloid, caffeine 
(C s H 10 N 4 O 2 .H 2 O) (which is methy-theobromine , isomeric with theine), 
and two peculiar principles, one resembling tannin, termed caffeo- 
tannic acid, and the other termed caffeic acid. The volatile oil, 
upon which the flavor depends, is developed by roasting. Coffee 
may be used for the general indications of antispasmodics, and is, 
besides, especially efficacious in relieving the sopor caused by 
opium-poisoning. Both tea and coffee lessen the urea in the urine. 
Coffee is relaxing, while tea is astringent, since it contains tannin. 
Salivary digestion is retarded by tea, § in part owing to its tannin ; 
theine, caffeine or the volatile oil exert no action on it, while coffee 
and cocoa are indifferent. Gastric digestion is restrained by tea, 
coffee and cocoa, ranking in this order; on pancreatic digestion 
they exert no influence. This kind of inhibition is not abnormal, as 
it contributes to a beneficial end, slow being quite different from 
imperfect digestion. 

Caffeina {Caffeine). Grains J^-iij produce decided cerebral 
effects, as excitement, wakefulness and hallucination, and, when 
exhaustion sets in, sopor. It increases the number of the heart's 
beats, and raises the arterial pressure, both being followed by feeble 
action and diminished blood-pressure. In frogs the motor and 
probably the sensory nerves are affected by it. Injected into dogs 



*" Chemistry, Gen., Med. and Pharm.," 10th ed., p. 398. 

f Medical News, April, 1886. 

\ Cinn. Lancet and Clinic, Jan., 1886. 

$" Lectures on Dietetics and Dyspepsia," 1886, p. 28, et al. Wm. Roberts. 

9 



130 MATERIA MEDICA AND THERAPEUTICS. 

and cats, it produces tetanus (Aubert). In cats * the increased 
flow of urine is coincident with dilatation of the blood-vessels, and 
it augments the volume of the kidneys. Applied to a cut-out 
muscle, it causes rigidity (coagulates the myosin) and abolishes the 
electrical contractility. Caffeine elevates and then lowers the ani- 
mal temperature, and has decided diuretic powers (Gubler). Its 
efficacy in diminishing the dropsy of cardiac and other affections, by 
increasing the urinary flow, has recently been investigated by 
Stahl,f who reports favorable results from its employment. In man 
gr. vii-xij have caused decided cerebral effects, but no deaths have 
followed its use. Caffeine has been used as a cerebral stimulant in 
nervous headache (gr. j-ij), in cardiac dropsy (gr. v), being a power- 
ful diuretic, and to antagonize morphine narcotism. Caffeine citrate 
is the salt most in use. Caffeine valerianate is useful in hysterical 
vomiting, in the dose of gr. j-ij repeated. None of the salts of this 
alkaloid are official. 

III. Theobroma — Chocolate (noticed more at length under the 
head of demulcents — see Oil of Theobroma) contains a nitrogenous 
principle, theobromine, nearly identical in composition with caffeine 

(C.H 8 N 4 2 )- 

IV. Erythroxylon — Coca or Cuca. — The leaves of E. Coca {Nat. 
Ord. Erythroxylaceae) have long been used as a masticatory by the 
Indians in Peru for the purpose of enabling them to undergo fatigue, 
hunger and thirst. An alkaloid termed cocaine (C 17 H 21 N0 4 ) has 
been found in coca, also cocatannic acid, which yields with the iron 
salts a green precipitate. Hydrochloric acid is also incompatible, as 
it splits cocaine into methylic alcohol, benzoic acid and ecgonine. 
The most interesting effects of coca in man are cerebral stimulation, 
lessening of the feeling of fatigue, the ability to remain for a long 
time without food, increased cardiac action and elevation of temper- 
ature. Coca \ lessens the excretion of urea and the urinary flow. 
Large doses cause muscular weakness, drowsiness and tinnitus 
aurium (Ott). Coca has been but little used in medicine, though 
its use is indicated in diseases requiring the checking of tissue 
waste, as phthisis. In cases of mental and physical fatigue de- 
pendent on overwork the wine or fluid extract repeated until 



*Joum. of Physiol., 1887, viii, p. 117. Experiments by Phillips and Bradford. 

f " Inaug. Diss., Wurzburg, 1887. 

\ Boston Med. and Surgical Journ., Sept. 7th, 1882. Mason. 



ANTISPASMODICS. 131 

the condition is relieved is a remedy of great value. The fluid 
extract is the best preparation ; dose, f5ss-ij. 

V. Cocaine (C 17 H 21 N0 4 ). — This alkaloid has attracted much 
attention, recently, from its power of producing local anaesthesia, 
which property, though first discovered by Professor von Anrep, * 
of Charkov, did not attract general attention until the publication 
of a paper on the subject by Dr. Karl Koller, in September, 
1884. The hydrochlorate, which is the salt in medicinal use, occurs 
in monoclinic prisms arranged in radial groups, soluble in alcohol 
and water. The free alkaloid is very unstable, contact with water 
being sufficient to decompose it. Neutral solution of the hydro- 
chlorate will keep for some time undecomposed. 

Test. — The Cocaine salts can be distinguished from the other 
alkaloids by adding chlorine water (2-3 c. c.) and 2 or 3 drops of 
palladium chloride which throws down a fine red precipitate dis- 
solved by sodium thiosulphate. 

Incompatibles. — The alkaline hydrates and carbonates, and 
borax throw down white precipitates with solution of cocaine hydro- 
chlorate. Boric acid added or as the menstruum prevents the de- 
composition with borax. 

Aids. — In its cerebral effects by alcohol and the cerebral stim- 
ulants, as cannabis Indica; its analgesic, by carbolic acid, opium and 
conium. 

Contraindications. — Being mostly eliminated by the kidneys 
chronic disease of these organs with obstruction of the urinary flow 
would be a reason for not giving cocaine in order to avoid toxic 
cumulative effects ; also in cardiac weakness. 

Physiological Effects. — A few drops of a four per cent, solu- 
tion applied to the conjunctiva rapidly produces anaesthesia of that 
membrane and cornea (lasting from 10 to 20 minutes), with contrac- 
tion of the vessels and anemia of the membrane and dilated pupil, f 
preceded by slight contraction (which is gradual, the maximum 
being attained at the end of an hour); accommodation is said to be 
but little affected. Jackson affirms that cocaine influences unfavor- 
ably the nutrition of the cornea afterward. Applied to the mucous 
membranes of the mouth, nose, larynx and trachea, urethra, vagina and 



* Pflicger's Archiv., 1879, XXI . P- 3 8 - 

f" The Influence of Cocaine on the Pupil and Cornea." By Edward Jackson, M.D. 
Trans. Coll. of Phys., 1887, p. 165. 



132 MATERIA MEDIC A AND THERAPEUTICS. 

rectum, it allays irritation, causes a superficial and temporary anaes- 
thesia, at the same time lowering the sensibility of the deeper tis- 
sues, contracting the vessels, producing anemia of the surface (best 
seen in the vessels which ramify through the mucous membrane 
covering the turbinated bones in the nose), and lowering reflex sen- 
sibility of the part. It is not readily absorbed by the conjunctivae 
unless used in excess ; the Schneiderian membrane, however, takes 
it up rapidly so that its cerebral effects are soon obtained by this 
route. Instilled into the external auditory meatus it causes a super- 
ficial diminution of sensibility without affecting the hearing, and 
lowers the temperature of this region. 

The account here given of the internal action of cocaine is 
based chiefly on Mosso's* elaborate investigations upon dogs, 
though its cerebral effects upon man will first be mentioned. Nerv- 
ous system: in medicinal doses (in man) it stimulates the functional 
activity of the brain, the intellectual faculties becoming more active 
and imaginative, while the entire economy experiences a general 
feeling of renewed vigor. This state is succeeded by one of depres- 
sion, and at the end by narcosis. Toxic amounts given to dogs in- 
duce symptoms of general paralysis, abolition of sensibility, cessa- 
tion of reflex action, cardiac weakness and stoppage of respiration. 
The irritability of the sensory nerves is destroyed, and, according 
to Ott, that of the motor nerves is much depressed. Intravenous 
injections, f in dogs, caused general convulsions from irritation of 
the medulla, dyspnoea, reddening and swelling of the exposed brain, 
and diminution in the excitability of the psychomotor centres ; the 
convulsive attacks were intermittent. Skeletal muscles: it induces, 
in full doses, muscular contractions of the trunk and extremities by 
excitement of the motor tracts of the cord, the cranial ganglia not 
being involved. Section of the cord between the occiput and atlas 
does not prevent this. A characteristic symptom of large doses is 
the production of sudden convulsions (not reflex) which resemble 
those of strychnia-poisoning. On the involuntary muscles cocaine 
sets up also contractions, and, if the dose be large enough, the 
urine and feces will be discharged involuntarily. According to 
Mosso the effects just noted are due altogether to an action on the 



* Arch, fur experiment. Pathol, u. Pharm., xviij, 1887, p. 153. 

■j" These pour le Doctorate en Medecine, Paris, 1887, par Y. Duchesne ; and Lancet, 
London, Sept. 19, 1891. 



ANTISPASMODICS. 133 

nerve-centres, and not to one upon the muscle-substance, as is 
affirmed by Ott and others. Vulpian * found that cocaine caused 
wide pupillary dilatation. The patellar reflex is at first heightened 
and afterward abolished. 

Circulation. — Cocaine increases the frequency and strength 
of the cardiac contractions, which are not dependent on paralysis of 
the vagi (Mosso). Anrep states, however, that the vagi are para- 
lyzed, so that the matter cannot be considered as yet settled. A 
reduction of blood-pressure succeeds full doses, which is followed 
by a rise, apparently due to a direct action on the vessels. The 
heart continues to beat after breathing has ceased. It stops the 
frog's heart in systole. Medium doses exert no influence on the 
vaso-motor centre or tonicity of the vessels. 

Respiration is increased, not by a reflex act, but by stimulation 
of the respiratory centre. A poisonous dose destroys life by paraly- 
sis of this centre. 

Temperature. — Grains ij injected into the jugular vein of a 
dog caused the rectal temperature to advance about i°, which in 
toxic amounts is followed by a fall. 

Secretions.— Vulpian (op. cit) could detect no increase in the 
hepatic, pancreatic, or salivary secretion, nor augmented flow through 
the ureters, but an augmentation in the sub-maxillary discharge 
was noted. As to the diuretic action of cocaine, Da Costa and C. 
B. Penrose f observed a decided increase in the quantity of urine 
and urates in nineteen out of twenty cases, with slight variations in 
sp. gr. They attributed its diuretic action to raised arterial tension. 
Elimination takes place, in part, by the kidneys, since it can be 
detected in the urine. 

When taken in full or continued doses, anorexia, insomnia, debil- 
ity and mental depression are fhe usual sequelae, a group of phenome- 
na that give evidence of the cocaine-habit. Cocaine induces increased 
metabolism throughout the economy as shown by elevated tempera- 
ture, rapid pulse and tissue waste, with urates in the urine, these 
changes varying relatively with the amount ingested. 

When administered hypodermically it causes no irritation. If 
the injection be made into the superficial tissues it acts as a local 



* Compt. Rendu, p. 836, 1884. 

t The Med. News, June, 1886. Observations on the diuretic influence of cocaine. On 
the toxicology of cocaine, see Med. and Surg. Reporter, 1891 ; and Maryland, Med. 
Journ., June, 1890, Mattison. 



134 MATERIA MEDICA AND THERAPEUTICS. 

anaesthetic, while a deep injection produces a slight, transitory, gen- 
eral lowering of sensibility, a rise in temperature of from o.5°-i.5° 
F., lasting several hours, dilated pupils with uncertain vision, and a 
stronger and fuller pulse, with increased power of the cardiac sys- 
tole and lowering of the arterial tension. 

Toxicology. — Numerous fatal cases have been reported both 
by injection and per orem, in which the fatal quantity varied so 
widely that the lethal dose cannot be accurately stated. It may be 
well, however, to cite such cases as death from the urethral injec- 
tion of f5i of a 20 per cent., and f5i of a 4 per cent., solution ; 
moreover, gr. xxii and xx by the stomach have destroyed adult 
life. The largest non-fatal injected dose is gr. xix ; the smallest 
fatal dose hypodermically is gtt. viij of a 4 per cent, solution. The 
autopsies showed congestion of the brain, lungs, liver and kidneys. 

Antidotes. — The poisonous effects of cocaine are antagonized 
by chloroform and ether, which tend to arrest the tetanus of the 
respiratory muscles. Amyl nitrite also has been used successfully 
to antagonize toxic doses of cocaine. After the immediate danger 
is passed chloral should be given, and to restore the breathing, 
artificial respiration should be practiced. 

Medicinal Uses. — It has been chiefly used locally, to prevent 
pain in operations on the eye, nose, larynx, vagina, rectum, etc. 
For this purpose the part is painted or sprayed with a 2-4 per cent, 
solution, and the application is renewed whenever the effect begins 
to wear off. In cases of photophobia, earaclie, acute myringitis, pain- 
ful deglutition (from tubercular or cancerous deposits in the pharynx 
or larynx), in vaginismus (to relieve the pain in order that an ex- 
amination may be made, or previous to the sexual act), and in 
spasm of the rectum or anus due to fissure, it may be used with great 
benefit. In acute gonorrhoea, f5ij of a* 4- 10 per cent, solution may 
be injected into the urethra, a few minutes before urination, to pre- 
vent pain during that act. In irritable stricture, or irritability with 
spasm of the sphincter vesicae, a small gelatin-bougie, containing 
gr. y^ of cocaine, has been passed down to the neck of the bladder 
and allowed to dissolve previous to a careful exploration of the 
urethra and bladder. A 20 per cent, solution has afforded relief in 
supra-orbital neuralgia, pruritus ani, and scrotal eczema, and it has 
been used for the relief of pain during the operation for phimosis. 
It has also been applied to painful ulcers and felons, either in powder 
or solution. 



ANTISPASMODICS. 135 

It is also recommended to produce contraction of the vessels 
and diminution of swelling in the mucous membrane of the nose and 
larynx, thus allowing the operator to obtain a better view of the 
parts during an operation, or as a means of preventing copious 
hemorrhage during operations on the nasal mucous membrane, or 
to check epistaxis. 

Locally it has been applied, by brush or spray, to control hay 
fever, acute nasal catarrh, etc., and to lessen cough in laryngeal af- 
fections. Solution of cocaine hydrochlorate, 4-8 per cent., intro- 
duced within the nasal cavities by the atomizer is the best remedy 
to relieve temporarily the occlusion of the nasal fossae in acute and 
chronic nasal catarrh. Collections of inspissated mucus should be 
first washed away with Dobell's solution. In an elaborate article 
by Hern* on the use of cocaine in dental surgery, the following 
conclusions are reached, viz., that it cannot be relied on for the relief 
of pain after extraction, or to deaden the sensibility of dentine, and 
as an analgesic to exposed pulps it is of doubtful utility. As a sub- 
mucous injection for the purpose of extraction it is inferior to nitrous 
oxide gas (summary of 90 cases). He considers it chiefly useful 
in the opening of abscesses, in the manipulation of models and instru- 
ments, and in operations on teeth with acute periostitis. Darierf 
states that it dilates the pupil without paralysis of accommodation, 
and that it is quite equal to atropine for the purpose of examining 
the fundus oculi. It has been used internally in gastro-intestinal 
neuroses, as gastrodynia, etc., in doses of gr. \-\ once or twice a 
day, in pill ; and as a cardiac tonic in weak heart and nervous palpi- 
tation. Prof. Da Costa| has called attention to the successful use 
of cocaine hydrochlorate as a heart-sustaining agent in low fevers, 
especially where there is cerebral disturbance added. He gave gr. 
Hi every two hours. 

Hypodermically it has been used to relieve pain in severe facial 
and other neuralgias, in acute pleurisy, prior to the accumulation of 
fluid, and before the performance of minor surgical operations, as 
the opening of abscesses, inflamed bursce, etc. 

When used for these purposes the needle of the syringe should 
not be inserted deeply, since superficial injections accomplish the 

* Trans, of the Odontological Society of Great Britain, 1886-7, p. 218. Cocaine and 
its uses as a local anaesthetic in dental surgery. 

f Bulletin Gen. de Therapeutique, cvii. De l'emploi de cocaine en Therap. oculaire. 
\ Phila. Med. News, Feb. 5th, 1887, p. 302. 



136 MATERIA MEDICA AND THERAPEUTICS. 

real object, viz. ; local anaesthesia ; when thrown in deeply there is 
no loss of sensation of the superficies (DaCosta*). Reclus,f basing 
his statement on 700 cases, directs as a matter of safety, the injec- 
tions to be made slowly with gradual withdrawal of the syringe as 
the fluid is forced out. Dumont and Barton advise, when cocaine 
is injected into the limbs for local anaesthesia, the application of an 
Esmarch's bandage by the manipulating of which the medicament 
may be allowed to enter the circulation slowly. Deep injections 
have been especially recommended when it is desirable to obtain 
promptly the stimulating effects which the drug exerts over the 
heart, as in collapse, the early stages of shock, weak heart and 
low fevers. 

Dose, internally, gr. ^-ss ; hypodermically, gr. %-%. 

VI. Guarana. — This occurs in chocolate-colored cylinders, 
which are worked up from the fruit of Paullinia sorbilis (Nat. Ord. 
Sapindaceae), a plant of Brazil, where it is used to make a common 
and highly-esteemed beverage. It contains more caffeine than any 
other vegetable substance, and also a variety of tannic acid. It is 
recommended, medicinally, as a tonic, astringent, and antispasmodic, 
and has been found especially useful in sick headache ; dose, 5j-ij, 
or an alcoholic extract may be given in doses of gr. x-xx. A tinc- 
ture and fluid extract may be used. The latter is official and can be 
given in doses of TTL x-xx, or more. 

VII. Mate. — Under this name the dried leaves of Ilex Para- 
guaiensis, a shrub of Paraguay, are extensively used in preparing a 
beverage throughout that region of country. Paraguay tea, as it is 
termed, has a balsamic odor and bitter taste, and contains a princi- 
ple identical with caffeine and theine, and also tannic acid. 

MOSCHUS— MUSK. 
Class, Mammalia ; Order, Ruminantia. 

Musk is a peculiar dried secretion obtained from Moschus 
moschiferus, the Musk Deer, an animal rather larger than the goat, 
and resembling the deer in its characters, which inhabits the moun- 
tainous portions of central Asia. The musk-bag is found only in 
the male, and lies between the umbilicus and prepuce. It is an 
oval pod, about two and a half inches long and one and a half broad, 



* Trans. Coll. of Physicians, 1886, 39. Hypodermic use of hydrochlorate of cocaine, 
f Gazette Hebdom., Paris 25 ser., 1890, xxvii. 



ANTISPASMODICS. 137 

flat on one side and convex and hairy on the other, and in a full- 
grown animal contains from 5jss to 5vj of a liquid secretion, which, 
when dried, is musk. Two kinds are known in commerce, the 
China and the Russia musk, the former of which is much the 
stronger. 

Musk occurs in grains or lumps concreted together, of a reddish- 
brown color, and has usually some hairs of the pod mixed with it. 
It has a powerful, diffusive, aromatic odor and a bitterish taste. It 
is inflammable, leaving a light spongy charcoal. On analysis, it 
yields ammonia, fat, cholesterin, gelatinous 'and albuminous principles, 
but the odorous principle has not been isolated. It is partially solu- 
ble in water and alcohol, and completely so in ether. 

Owing to its high price, musk is greatly sophisticated. Some- 
times artificial pods are met with, which maybe distinguished from 
the genuine by the absence of the remains of the penis, and of an 
aperture in the middle of the hairy coat. The musk itself is more 
frequently adulterated by mixture with dried blood and a variety 
of substances. Indeed, little if any genuine musk is found in the 
shops. 

Effects and Uses. — Musk is a powerful excitant and anti- 
spasmodic, without much effect on the cerebral functions. If a pure 
article could be obtained, it would have no superior as a direct anti- 
spasmodic in the treatment of essential nervous disorders — hysteria, 
epilepsy and chorea — and as a combined excitant and anti- 
spasmodic in the latter stages of typhus and typhoid pneumonia. 
But it is now little prescribed, owing to the difficulty of procuring 
it pure. 

Administration. — It may be given in the form of bolus or 
emulsion. Dose, gr. x, to be repeated every two or three hours. A 
tincture is official; dose, f5j. 

An article termed Artificial Musk is made by the addition of 
one part of rectified oil of amber to three parts of nitric acid. It 
resembles musk both in sensible and medicinal properties, and it has 
been prescribed in its stead, in the same dose. 

OLEUM SUCCINI— OIL OF AMBER. 

Amber, Succinum, derived from an extinct coniferous tree, 
Pinitis succinifer, is a fossil-resin found in various parts of the world, 
and comes to this country from the shores of the Baltic. It is a 
hard, brittle substance, usually translucent, and of a pale golden- 



138 MATERIA MEDICA AND THERAPEUTICS. 

yellow color, insipid and inodorous except when heated. By distil- 
lation it yields an oil, oil of amber {oleum succini), which, when 
rectified, is employed medicinally. The oil, soluble in alcohol, is 
nearly colorless at first, but gradually becomes brown, has a strong 
peculiar odor, and a pungent acrid taste. An acid called succinic is 
also obtained from amber. 

Effects and Uses. — Topically, it is an active rubefacient. Oil 
of amber is excitant and antispasmodic, and has been used in hysteria, 
epilepsy and hiccough. It is chiefly employed as an external rube- 
facient application. Dose of the oil, gtt. v to xv, given in emulsion. 
For external use it may be mixed with three or four parts of olive- 
oil and brandy, with one part of laudanum added. 

OLEUM ^THEREUM-ETHEREAL OIL. 

This substance, known also as oil of wine, is made by the dis- 
tillation of alcohol with a large excess of sulphuric acid; it is after- 
ward mixed with an equal volume of stronger ether. It is a trans- 
parent, nearly colorless, volatile liquid,' of a peculiar aromatic ethe- 
real odor and sharp bitter taste, sparingly soluble in water, but readily 
dissolved by alcohol or ether. Specific gravity 0.910. It has anti- 
spasmodic properties, but is used in medicine only as an ingredient 
of the compound spirit of ether. 

SPIRITUS ^ETHERIS COMPOSITUS— COMPOUND SPIRIT OF ETHER. 

This preparation, known as Hoffman s Anodyne, is a solution of 
ethereal oil (3 parts) in stronger ether (30 parts) and alcohol (67 
parts). It is a colorless, volatile, inflammable liquid, having an aro- 
matic ethereal odor, and a burning, slightly sweetish taste. It be- 
comes milky on being mixed with water, owing to the precipitation 
of the ethereal oil. 

Effects and Uses. — Hoffman's Anodyne has the antispasmodic 
and stimulant effects of ether, and derives additional tranquillizing 
and anodyne properties from the ethereal oil present; it is also an 
. efficient carminative. It is much used in hysteria, and is often added 
to laudanum to prevent the nausea which the latter sometimes 
excites. A good fever and tranquillizing draught is Tfy Spiritus 
aetheris compositi, f5j ; liquoris ammonii acetatis, tincturae opit 
camphoratae, aa f§ss ; aquae, ad f§jss. M. S. — One dose. Shake 
before using. Dose, f5j-ij, in sweetened water. 



TONICS. 139 



ORDER IV.— TONICS. 

Tonics, called also corroborants, are medicines which produce 
a gradual and permanent increase of nervous vigor. It is only, 
however, in certain conditions of disease that they manifest this in- 
vigorating influence ; as, in a state of health, they often act as irri- 
tants or even nauseants. Their local effects are similar to their gen- 
eral effects. They exalt the nervous functions of the parts to which 
they are applied, and increase their firmness and density. When 
taken into the stomach they produce a twofold corroborant effect, 
improving the digestive powers by their local action, and strength- 
ening the system generally by their cerebro-spinal influence. When 
given in very large doses, they produce nausea and vomiting, and 
when their administration is too long continued, they over-stimulate 
the gastric mucous follicles, causing a pathological secretion to be 
poured out, thus producing gastric catarrh. The after effect of 
tonics in large doses, especially of quinine, is one of depression 
upon the nervous centres. 

Tonics differ from stimulants only in the more permanent 
character of their effects. The more powerful tonics are closely 
allied to the narcotics in their action, producing, in overdoses, giddi- 
ness, loss of sight and of hearing, convulsions, delirium, and even 
death. And this analogy is further illustrated by the curative power 
of tonics in the relief of painful and spasmodic diseases, as neuralgia, 
rheumatism, chorea, and epilepsy. 

The articles of this class may be divided into vegetable and 
mineral tonics. The vegetable tonics are characterized by bitter- 
ness ; and it is said that they owe their bitterness and medicinal 
activity to a principle which has been termed bitter-extractive, or by 
some writers bitter-principle. Tonics should be given before meals. 
The mineral tonics unite astringent with tonic properties ; and the 
preparations of iron produce a further corroborant effect by increas- 
ing the red coloring matter of the blood. 

The therapeutic application of tonics comprises a diversi- 
fied range of diseases. They are employed as stomachics in dys- 
pepsia, and as general corroborants in convalescence from acute 
diseases, in chronic affections accompanied by marasmus and cachexia, 
in exhaustion and asthenia, in spinal irritation, hypochondriasis, sperma- 
torrhoea, typhus and gangrene, and in typhoid conditions of the system 
generally. But their most striking and valuable powers are shown 



140 MATERIA MEDICA AND THERAPEUTICS. 

in their febrifuge influence upon miasmatic diseases. The modus 
operandi here is obscure, but the curative powers are undoubted, 
and are generally attributed to their poisonous effects upon proto- 
plasm, thus destroying the germs on which these diseases depend. 
The antineuralgic and antispasmodic properties of tonics have been 
already alluded to. They also enjoy considerable reputation in the 
treatment of chronic bowel-complaints, where they act by restoring 
tone to the debilitated intestinal tube ; and, on the other hand, they 
are often useful as laxatives in torpid conditions of the alimentary 
canal. 

VEGETABLE TONICS. 

The vegetable tonics may be arranged into three sections, viz. : 
i. The Pure Bitters. 2. The Aromatic Bitters, which contain 
a stimulant volatile oil, and are aromatic as well as tonic. 3. The 
Astringent Bitters, which contain tannic and gallic acids, and are 
both astringent and tonic ; this group contains cinchona, the most 
powerful and important of the vegetable tonics. The bitter-princi- 
ple is also found in many medicines belonging to other classes, as 
rhubarb, aloes, taraxacum, etc, and imparts to them tonic properties. 

simple bitters. 

QUASSIA. 

Quassia is the wood of Picraena excelsa {Nat. Ord. Simaru- 
bacese), a lofty tree of Jamaica and other West India islands. It is 
imported from the West Indies in billets of various sizes, which are 
found in the shops in the form of chips or raspings. It has no odor, 
but an intensely permanent bitter taste. Water and alcohol extract 
its virtues, which depend on a neutral bitter-principle termed 
quassin (C 10 H 12 O 3 ). 

The article originally known as quassia was the root and wood 
of Quassia amara, a shrub of Surinam, but this does not now reach 
our markets. 

Effects and Uses. — Quassia is a mild tonic, free from irritant 
or astringent effects, and is employed principally in dyspepsia, want 
of appetite, and other stomachic affections. It promotes the appe- 
tite and digestion and causes a rapid development of strength. In 
diarrhoea from relaxation of the muscles, its use is of advantage. 
It increases* the saliva, milk, and secretions from the mucous mem- 

* Am. J. Phar., 1883, p. 472. 



TONICS. 141 

branes. It is much used to give additional bitterness to malt- 
liquors. It has proved a useful tonic in asthenia, atonic dyspepsia, 
anorexia , chlorosis , and lingering convalescence especially after fevers. 
Dose, in powder (rarely used), gr. xx to 5j ; but the best form of 
administration is that of infusion, in doses of fSjss to iij ; the infu- 
sion is a good remedy for thread-worms, given by enema. An 
extract (aqueous) is given in the dose of gr. v, but it is principally 
used as an excipient. A fluid extract is also official, dose Hf[v-xx. 
Of the tincture, 100 parts contain 10 parts of the powder, the dose 
is f5j to ij. 

GENTIANA— GENTIAN. 

Gentian is the root of Gentiana lutea or Yellow Gentian (Nat. 
Ord. Gentianacese), a perennial plant of the mountainous parts of 
central and southern Europe, growing to the height of two or three 
feet, with broad, ovate, opposite leaves and handsome whorled 
yellow flowers. It is imported in cylindrical, branched, twisted 
pieces, of various sizes, marked by transverse annular wrinkles and 
longitudinal furrows. Its odor in the fresh state is peculiar and 
disagreeable, but, when dried, feeble ; its taste is slightly sweetish 
and intensely bitter. Water and alcohol extract its virtues. It 
contains a fixed oil, an acid (gentisin or gentisic acid, C 14 H 10 O 5 ), pectin, 
grape-sugar, and a bitter-principle termed gentiopicrin (C 20 H 30 O 12 ), a 
glucoside, which is soluble in water and spirit of wine. Other 
species of gentian are employed as substitutes for the yellow gen- 
tian. The root contains no tannic matters (Maisch). 

Effects and Uses. — Gentian is a pure bitter, without either 
astringency or much aroma. In full doses it is more disposed to 
relax the bowels than the other simple bitters ; and, like others of 
the vegetable tonics, in excessive doses it is capable of producing 
narcotic effects. It is an admirable stomachic in anorexia, in all 
kinds of dyspepsia and convalescence, and is also used in the various 
forms of constitutional debility. In gastric dyspepsia, due to defi- 
ciency in the quantity of the gastric juice, gentian combined with an 
alkali will relieve the condition. 1^ Tincturae gentianae compositae, 
f5j ; liquoris potassae, TTLxv. M. S. — In a wine-glass of water be- 
fore meals. 

Administration. — In the form of powder, rarely given on 
account of its bitterness, the dose is gr. x to 5ss. Compound 
tincture (Tinctura gentiance composita, gentian 8 parts, bitter orange- 
peel 4 parts, cardamom 2 parts, to diluted alcohol enough to make 



142 MATERIA MEDICA AND THERAPEUTICS. 

the tincture weigh ioo parts), in the dose of f5j to ij ; extract 
(aqueous), in the dose of gr. x to 5ss ; and fluid extract, in the dose 
of f5ss-j. Gentian is often well combined with other bitters, as 
columba, cinchona, and the alkalies. 

CALUMBA. 

Columba or Columbo is now generally ascribed by botanists 
to Jateorrhiza Calumba {Nat. Ord. Menispermaceae), designated by 
some writers still under the old name of cocculus palmatus, a climb- 
ing plant of Mozambique, on the southeastern coast of Africa. The 
root is the official portion, and is known in Africa under the name 
of Calumb. It consists of fleshy tubers, with numerous offsets, 
which are the portions used, the main root being too fibrous. They 
are found in the shops in thin, circular disks about 2 in. in diameter, 
externally of a brown, wrinkled appearance, and internally yellow. 

Fig. 12. 




JATEORRHIZA CALUMBA. 

The odor is slightly aromatic, and the taste persistently bitter. Ow- 
ing to the starch which is found in columbo, it is liable to be worm- 
eaten. It contains, besides a large proportion of starch, two bitter- 
principles, colombin (C 42 H 44 14 ) and berberine (C 20 H 17 NO 4 see p. 143), 
columbic acid (C 22 H 24 7 ), but no tannin. Water and alcohol take up 
its virtues ; and from its liability to attract moisture from the air, it 
should not be kept in the form of powder. 

Effects and Uses. — Columbo is a very agreeable demulcent 
tonic, particularly acceptable to the stomach, and hence well adapted 
to the convalescent stages of acute disorders of the bowels and of 
fevers and to restore the appetite in anorexia. It is also a good, 
preparation in the sickness of pregnant women, and is one of the 



TONICS. 143 

best of the stomachics in all cases where there is unusual delicacy 
of the stomach. In its native country it is much employed in the 
treatment of dysentery. 

Administration. — The dose of the powder is gr. x-xxx (rarely 
used). It may be given in the form of infusion (dose, f5j to ij), 
which should be used at once, as it is liable to spoil. Of the tincture 
(10 parts to ioo parts of tincture) f5j to iv may be given. Of the 
fluid extract, the dose is foss-j. Columbo is often combined with 
the aromatics, alkalies and iron, and is sometimes added to purga- 
tive mixtures. 

Berberine (C^H^NOJ (not official), the alkaloid found in 
columbo, is widely diffused in the vegetable kingdom, and is obtained 
from numerous plants of the natural orders Berberacece, Menisper- 
macccB and Ranunculacece, as barberry, yellow-root, hydrastis, gold- 
thread and others It has been employed in the form of hydrochlo- 
rate and sulphate, as a tonic and febrifuge, in doses of gr. j-x. 

CHIRATA. 

Ophelia Chirata (Nat. Ord. Gentianaceae), an East Indian plant, 
has been introduced into European and American practice under 
the name of Chirata, where it now ranks among the best simple 
bitters. The entire plant is official. Chirata contains a peculiar 
neutral bitter-principle, termed chiratin (C 26 H 48 15 ), and ophelic acid 
(C^H^O^), which is amorphous ; in medicinal properties it resembles 
gentian, and may be used in the same way, particularly in anorexia 
and convalescence. Dose, of the fluid extract TTLv-xx ; of the tincture 

mv-f5j. 

aromatic bitters, 
serpentaria. 

The rhizome and rootlets of several species of Aristolochia 
are known under the name of Virginia Snakeroot. The most 
familiar is A. serpentaria (Nat. Ord. Aristolochiaceae), an herba- 
ceous, indigenous plant, with a perennial root, composed of numer- 
ous slender fibres, arising from a knotty, brown head. A. reticulata 
is a variety found in the southwestern States. 

Virginia snakeroot is found in the shops in tufts of long, 
slender, matted fibres attached to a knotty, rugged head. They 
are brittle, and of a yellowish-brown color. The odor is aromatic 
and camphoraceous ; the taste somewhat pungent, bitter and aro- 
matic. Water and alcohol extract its virtues, which depend on the 



144 



MATERIA MEDICA AND THERAPEUTICS. 



presence of a volatile oil, a bitter- principle •, resins and tannin. The 
roots of A. reticulata are very commonly substituted for those of 
A. serpentaria, from which they differ only in the larger size of 
their fibres. They are quite equal to the latter, and are thought 
even to contain a larger proportion of volatile oil. 

Effects and Uses. — Virginia snakeroot is a combined stimu- 
lant and tonic, with diuretic or diaphoretic properties, according to 



Fig. 13. 




SERPENTARIA. RHIZOME AND ROOTLETS. 



the mode of its administration. In full doses it irritates the alimen- 
tary canal, causing nausea, eructations and colic. It is much used 
in the latter stages of fevers, and in other acute diseases, in anorexia, 
and is frequently combined with Peruvian bark in the treatment of 
intermittents. It may be administered in infusion (not official), dose 
fgj to ij, repeated. Of the tincture (10 parts in 100 parts of tincture) 



TONICS. 145 

the dose isfoj to ij ; of the fluid extract, f5ss-j. Huxhairis Tincture 
contains serpentaria. 

EUCALYPTUS. 

The leaves of the Eucalyptus globulus {Nat. Ord. Myrtaceae), 
a lofty tree of Australia, commonly known as the Blue Gum-Tree, 
are classed among the aromatic bitters. The leaves should be col- 
lected from rather old trees. When fresh they are more active than 
when dried ; their taste is aromatic and camphoraceous. They owe 
their activity to a volatile oil, having the odor of oil of peppermint, 
which contains cymol (C 10 H 14 ), two terpenes, and eucalyptol (C 10 H 18 O) ; 
from eucalyptus are also obtained tannin, resin (crystallizable) and 
cerylic alcohol. 

Effects and Uses. — The oil possesses a decided destructive 
power upon infusoria, and locally is an irritant. Nervous system : 
large doses in animals produce muscular weakness, loss of reflex 
irritability, and finally death from centric paralysis (cord and 
medulla). These effects are preceded by a period of excitement. 
In small doses in man it causes mental activity and a feeling of well- 
being. The circulation and respiration are both accelerated by 
eucalyptus. Secretions : the ingestion of the drug augments the 
flow of saliva, promotes the appetite, causes diaphoresis, and, by 
stimulating the intestinal glands to activity, induces soft stools. 
It decidedly increases the elimination of urea (Gimbert). It is 
eliminated by the bronchial mucous membrane, kidneys and skin, 
imparting to the secretions of these organs the odor of the oil. 

Eucalyptus has been given with contradictory results in mias- 
matic fevers, in doses varying from 5j-iv of the dried leaves, or less 
of the fresh, but it is unlikely that it will ever supersede quinine as 
an antimiasmatic. The fluid extract is official ; dose, f5j in some 
aromatic water. 

Oleum eucalypti (commonly called eucalyptol) has proved effi- 
cient in bronchitis and whooping-cough ; dose, gtt. v-x in capsules or 
emulsion. 

Eucalyptus may be used as a tonic in gastric catarrh and dys- 
pepsia, and its employment in chronic cystitis is recommended. 
Indeed, its best effects are obtained in chronic affections of the 
mucous membranes, be they pulmonary, gastric, or vesical, and its 
beneficial influence in these diseases is due to contact of the oil 
during elimination with the surface. The growth of plantations of 
eucalyptus in miasmatic districts has been found to diminish the 
spread of malaria. 



146 MATERIA MEDIC A AND THERAPEUTICS. 



ANTHEMJS. 

Anthemis nobilis, or Chamomile (Nat Ord. Compositae), is a 
small herbaceous, trailing European plant, cultivated extensively in 
both Europe and this country. The flower-heads are the portions 
used. They consist of small spheroids, with convex yellow disks 
which contain the aromatic properties, and numerous white, spread- 
ing rays. Chamomile flowers have a bitter, aromatic taste, probably 
due to authentic acid y and a strong, peculiar odor, both of which are 
imparted to water and alcohol. They contain a volatile oil, bitter- 
principle, a little tannic acid, and resin, but no alkaloid* has been 
obtained. 

Effects and Uses. — Chamomile, in small doses, is a mild, 
agreeable, aromatic tonic, and, in large doses, acts as an emetic. 
The cold infusion is much employed as a stomachic, in dyspepsia 
with flatulence, and the hot infusion is given to aid the operation 
of emetics. The flowers, boiled in water, form a good fomentation 
to inflamed parts. The usual form of administration is the infusion. 
Dose, as a stomachic, f§ij, two or three times a day, cold; as an 
emetic, hot, ad libitum. 

Matricaria. The flower-heads of Matricaria chamomilla or 
German chamomile (Nat Ord. Compositae), an annual European 
plant, possess properties very similar to those of chamomile. They 
contain volatile oil, bitter- extractive, tannin, and malates. They are 
not much employed in this country. 

eupatorium. 

Eupatorium perfoliatum, Boneset, or Thoroughwort (Nat Ord. 
Compositae), is a very common indigenous plant, growing in wet 
grounds in every past of the United States. It has numerous herb- 
aceous stems, with long, narrow leaves, perforated by the stems. 
The leaves and flowering tops are the official portion. They have 
a faint odor, a strongly bitter taste, impart their virtues to water or 
alcohol, and contain a bitter glucoside, called eupatorin ; also gum, 
tannic acid, and a trace of volatile oil. In the leaves are found also 
resin, wax, and gallic acid.\ E. teucrifolium, E. aromaticum, and 



* Am. J. Pharm., 1889, p. 69. 

f Am. Jotirn. of Pharmacy, F. W. Franz, Analysis of the Leaves of E. perfoliatum, 
Feb., 1888, p. 77. 



TONICS. 



147 



other native species, are almost identical in their properties with E. 
perfoliatum. 

Effects and Uses. — Thoroughwort is a stimulant tonic, dia- 
phoretic and expectorant, and in large doses proves emetic and lax- 
ative. It is a good stomachic in dyspepsia and anorexia, and, from 
its combined corroborant, expectorant, and diaphoretic properties 



FIG. 14 



0mM^Mim^ 4« 




EUPATORIUM PERFOLIATUM. FLOWERING TOPS. 

is an excellent remedy in epidemic influenza, and in the latter stages 
of pneumonia and bronchitis. It may be given in infusion, f gij of 
which may be taken cold, as a stomachic, three or four times a day, 
and in freer warm draughts as a diaphoretic ; but the fluid extract is 
to be preferred; dose, f5j. 



ABSINTHIUM. 

The tops and leaves of Artemisia Absinthium, or Wormwood 
(Nat, Ord, Composite), a European plant, naturalized in New Eng- 
land, are ranked among the aromatic bitters, but are not now much 
employed. They may be given in infusion. 



148 MATERIA MEDICA AND THERAPEUTICS. 

Wormwood contains an essential oil (chiefly absinthol), a bitter- 
principle termed absinthin (C 40 H 58 O 9 ), tannin, etc. According to 
Magnan,* absinthe given to animals in small doses induces brisk 
muscular contractions, while large amounts provoke attacks in which 
the animal falls in tonic and clonic convulsions, with stertorous 
respiration, and involuntary fecal and urinary evacuation. The con- 
vulsions are not prevented by depriving the animal of its cerebral 
lobes. He points out, too, that absinthe epilepsy " is a kind of in- 
toxication " to which is added the phenomenon of epilepsy. The oil 
possesses powerful stimulant properties, in large doses producing 
epileptiform convulsions, and in lethal quantities ((5*4) is capable of 
causing poisonous symptoms. No fatal cases, have, however, been 
recorded. f A liqueur termed absinthe, containing the oil in question, 
is much used in France, with highly pernicious effects. It enters 
into the composition of vinum aromaticum. 

MAGNOLIA. 

The barks of Magnolia glauca, Magnolia acuminata, and Mag- 
nolia tripetala (Nat. Ord. Magnoliaceae), indigenous trees remarkable 
for the beauty of their foliage and the size and fragrance of their 
flowers, are official, and rank with the aromatic bitters. The barks 
(quilled, thin, and inodorous) of the trunk, branches and root, are 
alike official ; but those of the last are the most active. They con- 
tain a volatile oil, tannin, resins, and a crystallizable bitter-principle 
(Lloydf). An extract of the fruit of M. umbrella yields magnolin. 
The aromatic property is impaired by drying, and is lost when the 
barks are long kept. 

They are used as gentle stimulant tonics in anorexia, and dia- 
phoretics in the low stages of fever, rheumatism, etc. An infusion 
may be given, but the best solvent is diluted alcohol. 

CASCARILLA. 

This is the bark of Croton Eluteria (Nat. Ord. Euphorbiaceae), 
a small tree of the Bahamas and other West India islands. It occurs 
in the form of small, thin, quilled pieces, though sometimes in frag- 
ments, having a grayish, easily detached corky layer and an inner 

* Compt. Rendu, 1869, p. 825. 
"f" Woodman and Tidy, 1882, p. 268. 

% " Drugs and Medicines of North America," Nos. 1 and 2, 1886. See also Am. J. of 
Pharm., Jan., 1889. 



TONICS. 149 

smooth surface. Its taste is warm and bitter. It yields its properties 
to alcohol, and partially to water; and contains volatile oil, resin, a 
crystalline bitter-principle called cascarillin, and some tannin. 

Effects and Uses. — Cascarilla is a very pleasant aromatic 
bitter, causing neither vomiting nor purging, and hence agreeing 
very well with the stomach. It may be given in powder in the dose 
of gr. xx to 5ss ; but this is a less agreeable form than the infusion ; 
dose, foij ; useful in anorexia. 

ASTRINGENT BITTERS. 
CINCHONA. 

The name Cinchona (derived from the Countess of Chinchon, 
wife of a viceroy of Peru) is applied to the bark of different species 
of Cinchona (Nat. Ord. Rubiaceae, Cinchoneae), large trees which 
grow in the mountainous regions of the western portions of South 
America, from the 22nd of south latitude to about the ioth° of north 
latitude. Two principal varieties of cinchona are known in com- 
merce : Cinchona Flava ( Yellow Bark), called in commerce Calisaya 
Bark, derived from Cinchona Calisaya ; and Cinchona Rubra (Red 
Bark), derived from Cinchona succirubra. The Pharmacopoeia now 
recognizes, however, as official the barks of all species of the genus 
Cinchona which contain at least three per cent, of the proper cin- 
chona alkaloids. It acknowledges the following species, viz. : C. 
officinalis, C. micrantha, C. calisaya, and C. ovata. 

Cinchona is brought to the United States from the Pacific ports 
of South America. It is obtained by stripping the trunks and 
branches of the Cinchona trees during the dry season, and is dried 
by exposure to the sun, during which process the smaller pieces usu- 
ally become quilled. 

1. The Yellow or Calisaya Bark comes both in quilled and flat 
pieces. The former are from three or four inches to a foot and a 
half long, from a quarter of an inch to two or three inches in diam- 
eter, and of variable thickness. They have a brownish epidermis 
(with longitudinal wrinkles and transverse fissures), which possesses 
none of the virtues of the bark. The bark itself is one or two lines 
thick, compact, of a short, fibrous texture, and when broken presents 
shining points. The flat pieces, which are derived from the larger 
branches and trunk, are usually destitute of epidermis, are more 
roughly marked externally, and are of a browner hue than the quilled 
pieces. They are also less compact, less bitter, and of less medicinal 



150 MATERIA MEDICA AND THERAPEUTICS. 

virtue. The yellow bark is distinguished from the other barks by 
its much more bitter taste ; its comparative freedom from astringency ; 
its brownish-yellow, somewhat orange color, which is still brighter 
in the powder ; and by containing a large proportion of quinine with 
very little cinchonine. 

2. The Red Bark usually comes in large, thick, flat pieces ; 
sometimes also in quills from half an inch to two inches in diameter. 
They are covered with a reddish-brown, rugged epidermis, beneath 
which is a dark-red, brittle and compact layer, the interior parts 
being woody and fibrous and of a lively brownish-red color. The 
taste of red bark is bitter and astringent ; its odor not different from 
that of the other barks ; its powder is reddish. It contains consider- 
able quantities both of quinine and cinchonine. 

Bale Bark, called in commerce Loxa and Lima Bark, derived 
from C. condaminea and C. micrantha is no longer official. It comes 
in thin quills of a pale fawn-color. The pale barks contain a much 
larger proportion of cinchonine than of quinine ; and, from their yield- 
ing little of the latter alkaloid, have fallen into disuse in the United 
States. 

Under the name of Carthagena Barks, large quantities of very 
good bark have been imported from New Granada, and are now 
used in the manufacture of quinine, under the name of Colombian 
barks. Their percentage of alkaloids varies greatly. 

Within a few years, the cultivation of several varieties of cin- 
chona trees has been successfully introduced into India, the islands 
Ceylon and Java, and also into Jamaica, and the markets are now 
supplied with barks of very good quality from these sources. 

Chemical Constituents and Tests. — The most important 
constituents of cinchona are two alkaloid-principles, termed Quinina 
[Quinine) and Cinchonina {Cinchonine), which exist chiefly in combi- 
nation with an acid called kinic (inert). These alkaloids are found 
in different proportions in the different barks, quinine being obtained 
from the yellow bark most abundantly, cinchonine from the pale 
bark, and the two principles in about equal proportions from the 
red. bark. Two other valuable alkajpjds, quinidine and cinchonidine . 
are found (also as kinates) most abundantly in the pale and Cartha- 
gena barks, but to a certain extent in all; also the alkaloids, aricine, 
paricine, quinamine, and paytine, have been discovered in cinchona. 
Other principles found are cincho-tannic acid, coloring matter, kinovic 
acid, starch, fatty matter, and a trace of volatile oil. Gum is found 



TONICS. 151 

in the pale bark, but not in the yellow or red bark. By heat, the 
crystallizable alkaloids are converted into amorphous modifications, 
as quinine into quinicine and cinchonine into cinchonicine 

Quinine is obtained by heating the sulphate with an alkaline 
solution. Quinine Sulphas {Quinine Sulphate) is prepared in the 
following manner: Powdered yellow bark is boiled in water acidu- 
lated with hydrochloric acid, by which the alkaloid is separated 
from its combination with kinic and other acids, to form a soluble 
hydrochlorate. By the addition of lime, this salt is decomposed, 
and quinine precipitated. The precipitate is washed with distilled 
water, and is separated from insoluble impurities by digestion in 
boiling alcohol, which is afterward distilled off. To the residual 
brown viscid mass, mixed with distilled water and heated to the 
boiling point, sulphuric acid is added, in quantity sufficient to dis- 
solve the quinine. The liquor is then boiled with animal charcoal, 
filtered, and set aside to crystallize. Modern methods of manu- 
facture have much cheapened quinine, benzoated amylic alcohol 
being employed to exhaust the bark. The alkaloid quinine may be 
obtained in the form of fine crystalline needles of a silky lustre, but 
usually occurs as a loose white powder; it is inodorous, very bitter, 
and alkaline. It (the hydrate) is soluble in 1670 parts of cold water, 
and in 773 parts of boiling water, in little more than its weight of 
alsolute alcohol, in about 5 parts of chloroform, and in 25 parts of 
ether, and also in the fixed and volatile oils. It unites with acids 
to form salts, the most important of which is the official salt, the 
sulphate. Its composition is C 20 H 24 N 2 O 2 .3H 2 O. Quinine and its 
salts may be distinguished from all other vegetable alkalies and 
their salts (excepting quinidine and quinicine) by forming an emer- 
ald-green precipitate when treated first with fresh chlorine-water 
and then with ammonia (Thalleioquin test, detects 50V0 P ar t, Fliick- 
iger). HerapatJis test is made by adding to quinine sulphate (gr. v) 
diluted acetic acid (f5j) with alcohol (f5ss) and tincture of iodine (8 
drops), heating gently over a spirit-lamp till it forms a clear light- 
brown solution, when, as the liquor cools, right-angled, quadrate, 
rhombic crystals are deposited, which by reflected light appear of a 
copper-green color, resembling the elytra of Spanish flies. This 
precipitate, which is quinine iodosulphate (C 20 H 24 N 2 O 2 SO 4 H 2 I 2 ), is 
termed Herapathite. Cinchonine is a white crystalline substance, 
less bitter than quinine, almost insoluble in cold water, very soluble 
in boiling alcohol, and slightly soluble in ether and the fixed and 



152 MATERIA MEDICA AND THERAPEUTICS. 

volatile oils. Its composition is C 20 H 24 N 2 O. It is distinguished 
from quinine by striking a white precipitate when chlorine-water and 
afterward ammonia are added ; with potassium ferrocyanide, a yel- 
lowish-white precipitate falls. As cinchonine is but slightly sol- 
uble in ether, while quinine is soluble in that menstruum, the latter 
may by this means be readily separated from the former alkaloid. 
The medicinal properties of quinine and cinchonine are analogous, 
and cinchonine sulphate is now official. Quinidine is isomeric with 
quinine, but more crystallizable and less soluble in ether ; its salts 
strike a white precipitate with solution of potassium iodide. Cin- 
chonidine is isomeric with cinchonine. It is usually found mixed 
with quinidine the mixture being known as commercial quinidine. 
The commercial quinidine sulphate (which is more soluble in water 
and alcohol than quinine sulphate) may be used as a substitute for 
the latter salt. 

Incompatibles. — The alkalies and alkaline earths precipitate 
the alkaloidal principles of cinchona ; tannic acid, and the tincture 
and compound solution of iodine, form with them insoluble com- 
pounds ; the ferric salts precipitate cincho-tannic acid ; solution of 
potassium arsenite is also incompatible with infusions and decoctions 
of cinchona, as it forms a precipitate with them. 

Aids. — As a tonic such bitters as gentian, quassia, serpen- 
taria, and nux vomica. Its antipyretic effect is enhanced by anti- 
pyrine, antifebrin, resorcin, and salicylic acid. As an antiperiodic 
eucalyptus, carbolic acid, creasote, arsenic, though for this effect it 
is best given alone. Aconite increases its sedative cardiac influence. 

Physiological Effects. — Locally, cinchona and its alkaloids 
act as irritants, and possess, besides, a marked antiseptic power, arrest- 
ing putrefaction and fermentation by a destructive influence upon 
fungi and infusoria.* As the physiological action of cinchona de- 
pends on its contained alkaloids (chiefly quinine), the following ac- 
count relates to the latter. Nervous system : quinine in medicinal 
doses stimulates the cerebral functions and increases the mental 
activity. Full doses (gr. xv-xx) induce a hyperemic condition of 
the brain, the first indications of which are felt by the special senses, 
especially that of hearing, which undergoes subjective noises, as 
ringing and roaring in the ears {tinnitus auriuni), with partial deaf- 



* Arch, de Physiol. Norm, et Pathol., v, 1873, p. 389. L'action de la quinine sur les 
vibrioniens et sur les mouvements amiboi'des ; par Bochefontaine. 



TONICS. 153 

ness, the latter rarely permanent; amblyopia is an accompaniment, 
though less common. Doses of this size, continued, may produce 
a sense of fullness of the head, frontal headache and vertigo. Very 
large doses augment the above symptoms, which are accompanied 
by a slow, weak pulse, dilatation of the pupils, convulsions and 
stupor; death in rare cases has followed quinine-poisoning, though 
immense doses of it have been taken with impunity. Quinine given 
to frogs reduces and finally abolishes the reflex excitability of the 
spinal cord. Its effect in this respect, on man, is as yet sub judice- 
When taken in doses of gr. x-xx, during labor, it energizes the 
uterine contractions. Circulation : in small doses quinine slightly 
accelerates the action of the heart; while large amounts (gr. xl-lx) 
decidedly retard its beats and force, and sometimes cause it to inter- 
mit, especially in children. This retardation occurs after section of 
the vagi, indicating a direct influence on its motor ganglia ; applied 
in solution to the cut-out heart it quickly stops its movements. The 
cinchona alkaloids are readily dissolved from the bark by contact 
with the gastric juice, and being diffusible and crystalline, quickly 
osmose into the blood ; if, however, from any cause, they pass into 
the small intestines, contact there with the alkaline fluids of that tube 
will precipitate them, and they will be discharged with the feces. 
Upon the blood, quinine has several marked actions, as follows : 
both in health and inflammation it diminishes the number of white 
corpuscles, and retards their amoeboid movements (Binz) ; Schwalbe's 
investigations, however, do not confirm those of Binz; it hinders the 
carrying of oxygen to the tissues, and increases the proportion of 
red to white corpuscles (Cutler and Bradford). The absorption of 
quinine by the blood is aided by the carbon dioxide gas of that 
fluid. It is unknown how it exists there. The production of acid 
in freshly-drawn blood is diminished by the addition of quinine-solu- 
tion (Binz). Temperature : in small doses in health no influence 
upon the animal heat has been noted; but in large amounts a mod- 
erate fall takes place (about y 2 ° F.). No complete explanation has 
as yet been given of this action, but it seems to be due to an inter- 
ference with the oxidation-processes in every part of the body. 
Secretions : cinchona stimulates the peptic glands, increasing their 
secretion and consequently the appetite and digestion, and, from the 
tannic acid which it contains, produces a slightly astringent effect 
not belonging to the salts of its alkaloids. If given too long, or if 
the stomach and bowels are in an irritable condition, it is soon apt 



154 MATERIA MEDICA AND THERAPEUTICS. 

to produce nausea, vomiting, and even diarrhoea. Occasionally 
quinine causes a cutaneous eruption, as erythema, herpes, etc. A 
rarer effect is renal and cystic irritation. Quinine, it is said, causes 
contraction of the spleen (Piorry); this, however, has been denied. 
Large doses of quinine (gr. xxv-xl) decidedly diminish the amount 
of urea and uric acid in the urine, also the phosphoric acid. Elim- 
ination * : quinine is eliminated chiefly by the kidneys, and it has 
been found in the urine twenty minutes after the subcutaneous 
injection of a large dose. According to Thau from y 2 to % escapes 
in the first six hours. It is discharged partly as quinine and partly 
as isomeric modifications (quinicine). 

Medicinal Uses. — Though the medicinal value of cinchona, 
or its alkaloid, quinine, can scarcely be over-estimated in the treat- 
ment of various diseases, yet its chief therapeutic applications may 
be divided into three classes, in the following order of merit: 
i. Antiperiodic; 2. Antipyretic; 3. Tonic. The most important 
therapeutic employment of cinchona is as an antiperiodic in the treat- 
ment of fevers of a miasmatic origin. Its efficacy in these diseases 
was first made known to the world by the Jesuit missionaries in 
Peru, from whom it was called Jesuit's powder. As cinchona itself 
is now rarely administered internally, the following remarks apply to 
its alkaloids, on the presence of which its powers depend. The type 
of miasmatic fever in which the effects of quinine are most strikingly 
displayed is intermittent, the non-pernicious and uncomplicated forms 
of which it rarely, if ever, fails to control. It may be given in these 
cases from the very onset of the attack; and if, owing to gastric 
irritability, it is rejected by the stomach, it should be introduced by 
the rectum or by hypodermic injection. In remittent fevers, quinine 
is scarcely less useful than in inter mittents ; and most physicians 
who practice in miasmatic districts now concur in recommending its 
early exhibition in these fevers, without waiting for a remission. In 
either disease the best time, as a rule, for its administration, since the 
major portion is eliminated in the first six hours, is from four to six 
hours preceding the expected paroxysm, and should it be desirable 
to get its effects quickly, on an empty stomach and in solution. If 
the onset be accompanied by violent headache and bounding pulse 
morphia subcutaneously and tincture of aconite should be given 
with it. In the pernicious or congestive forms of intermittent and re- 

* Bull. Gen. de Therap,, t. xci. Rienzi. 



TONICS. 155 

mittent fevers, the early administration of large doses of quinine or 
cinchonine, in combination with stimulants, is imperatively de- 
manded; and the hypodermic injections of quinine sulphate (gr. iij-v) 
may even be necessary. As a prophylactic against miasmatic fever 
and in the malarial cachexia, the use of the preparations of cinchona 
is very efficacious. We now seem to be approaching an explana- 
tion as to the exciting cause of miasmatic fevers and the specific ac- 
tion of quinine against them, due to the researches of Marchiafava* 
and Celli on the plasmodium malariae ; of Laveran,f on the microbes 
found by him in the blood; of Councilman and Abbott,"); on certain 
hyaline bodies discovered by them also in the blood; and, lastly, to 
Osler,§ on the haematomonas malariae. These observers, with singu- 
lar unanimity, have found certain microbes in the blood of persons 
suffering with miasmatic fever, the vitality of which was destroyed 
by quinine. But it is yet too soon to formulate a positive theory 
which will surely connect the presence of these microbes with an 
attack of ague and the destructive action of quinine upon them. 
The antipyretic power which the quinine salts possess renders their 
use extremely valuable in conditions of fever. In such states quinine 
is best given in a single large dose (5ss to 5j), and since the elimina- 
tion of the major portion of it takes place in the first six hours, it 
may be necessary to repeat this dose at the expiration of that time, 
if it be desirable to sustain its antipyretic effect. In Germany, the 
treatment of typhoid fever with large doses of quinine, gr. xx to xl, 
given in the evening, is in vogue. On account of the cardiac weak- 
ness, anorexia, and nervous depression produced by the salts of 
quinine, they should not be given in large doses in pneumonia^ In 
erysipelas, the author has found quinine sulphate scarcely, if at all, 
less efficient than in miasmatic fevers, and it should be given gr. 
iij-v, t. d., frequently combined with large doses of iron (a. v.). In 
puerperal septicemia, quinine may be given as an antipyretic in addi- 
tion to antiseptic, uterine and vaginal injections, with digitalis, as indi- 
cated, and opium, stimulants and easily assimilated food. In the treat- 



;i: "Bull. d. r. Accad. Med. di Roma, 1886, xii, 19-22. Marchiafava E. Richerche sull'. in- 
fezione malaria. 

tTraite des Fievres Palustres, par A. Laveran, 1884, p. 448. 

%Am. J. M. S., April, 1884, p. 416. 

\Brit. Med. Jour., March 12th, 1887, p. 556. 

\N. Y. Med. Rec, Jan. 29th, 1887. Discussion on the use of quinine in pneumonia ; N. 
Y. Academy of Medicine. 



156 MATERIA MEDICA AND THERAPEUTICS. 

ment of after-pains, when opium has failed, quinine in doses of gr. x 
bis die., often gives relief. In all conditions of hyperpyrexia, as in 
acute rheumatism, the exanthemata and pyemia, it is still employed, 
although the phenol-derivatives (e. g. antipyrine), are superseding it 
to reduce temperature. As a general tonic and stomachic in anor- 
exia, asthenia, and neurasthenia, cinchona and its alkaloids are also 
much used, but where gastric susceptibility exists, some of the 
simple bitters may be preferable. In convalescence from acute dis- 
eases, as the continued and eruptive fevers, in the hectic of phthisis, 
and in typhoid conditions generally, it is constantly prescribed. In 
the various neuralgic?, a large dose of quinine combined with mor- 
phine or belladonna, or smaller doses with arsenic and iron, form an 
effective plan of treatment. By its contracting action on the gravid 
uterus, quinine sulphate exerts an influence in promoting normal 
labor, and will often prove useful in counteracting inertia of the 
uterus in parturition. A full dose of quinine will sometimes abort 
an impending paroxysm of asthma. In surgical shock, as after grave 
operations, the administration of quinine is of the greatest utility. 
There are many other maladies, besides, in which cinchona or its alka- 
loids render important aid, as to combat the fever and bone-pains of 
dengue obstinate though they be; in pericarditis before marked effu- 
sion has taken place; as a tonic in emphysema, influenza and hay- 
fever ; to relieve headache (browache) ; and in the management of ex- 
ophthalmic goitre, purpura and yellow fever. In acute inflam- 
mations, if the researches of Binz be correct, quinine in the first 
stage is the remedy to be employed in order to prevent the exuda- 
tion of leucocytes, and for this object about gr. y^ to each pound of 
the patient's weight will be needed. The systemic effects of quinine 
may be obtained by introducing it within the rectum in suppository 
or enema; but it is advisable only to so use it when its administra- 
tion by the mouth is contraindicated. Topically, cinchona is em- 
ployed as an astringent and antiseptic. A lotion of quinine sul- 
phate is used in alopecia. 

Administration. — The use of cinchona in powder has been 
almost abandoned, owing to its bulk and disagreeable taste. When 
exhibited in this form oss to jss is the dose as an antiperiodic given 
usually in divided amounts; as a tonic, 5j. The following official 
preparations are employed : infusion (6 parts of the powder to water 
IOO parts, to which aromatic sulphuric acid I part is added), dose, 
fgij, repeated; extract (of yellow bark), dose, gr. x-xxx, equivalent 



TONICS. 157 

to 5j of bark; fluid extract (yellow), dose, f5j, equal to 5j of bark ; 
tincture (20 parts yellow bark to a mixture of 10 parts of glycerin 
with sufficient alcohol and water to make 100 parts of the tincture), 
dose, foj-iv; compound tincture [HuxJiam's\ (containing red bark 
10, bitter orange-peel 8, serpentaria 2, glycerin 10, alcohol and 
water to make 100 parts of tincture), dose, f5j-iv. In prescribing 
bark, opium or port wine is often given with it, when it acts on the 
bowels. It is also occasionally combined with serpentaria, and 
when the stomach will not retain it, it may be administered by the 
rectum, or even the hypodermic exhibition of the quinine sulphate 
may be resorted to. When administered subcutaneously the danger 
of the formation of a small abscess at the seat of introduction must 
not be lost sight of, and a salt soluble in water should be selected, 
as the bisulphate, the solubility of which may be increased by the 
addition of tartaric acid. 

Quininae Sulphas {Quinine Sulphate). This salt is prepared by 
the process described at p. 151. It occurs in fine, silky, rather 
flexible needle-shaped crystals (interlaced among one another, or 
grouped in small star-like tufts), which are odorless, very bitter, and 
slightly efflorescent. It is soluble in 740 parts of cold and 30 parts 
of boiling water, readily soluble in alcohol, but insoluble in ether. 
Quinine is a ternary base, and forms, with sulphuric acid, a basic, 
normal and acid sulphate. Basic quinine sulphate, 2(C 20 H 24 N 2 O 2 ) 
S0 4 H 2 + 7 aq., is the salt in common use. By the addition of 
dilute sulphuric acid to the basic salt normal quinine sulphate 
(QoH^N^C^.SC^Hg -f- 7 aq.) is obtained in four-sided prisms, which 
are soluble in 11 parts of cold water. Acid quinine sulphate 
(C^H^N^O^SO^H^ + 7 aq.) occurs as white prisms, freely soluble 
in water. Solutions of quinine and its salts possess the property of 
fluorescence and left rotary power on polarized light. Various sub- 
stances are mixed as adulterations with quinine sulphate. They may 
be detected by adverting to their relative solubility in different men- 
strua, as compared with the sulphate, or by chemical tests. Thus, 
gum and starch are left behind by alcohol ; salicin becomes red on 
contact with sulphuric acid, etc. 

Incompatibles. — Quinine sulphate is decomposed by the alka- 
lies, their carbonates and the alkaline earths. With the alkaline 
acetates and Basham's mixture quinine acetate is formed sparingly 
soluble. In solution it forms white precipitates with liquor potassae, 
sodae, and aqua ammoniae. The tannic acid of astringent infusions 



158 MATERIA MEDICA AND THERAPEUTICS. 

throws down a white compound, and the soluble lead salts, oxalic, 
tartaric and gallic acids yield a precipitate with it; with compound 
solutions of iodine, quinine iodide is formed. 

Effects and Uses. — The effects of quinine sulphate on the 
system are the same as those of cinchona, and, from its being less 
apt to disagree with the stomach, it has almost superseded the use 
of the latter. See p. 152. 

Administration. — The ordinary dose of the quinine sulphate* 
is as an antipyretic gr. x-xx, repeated as indicated, as an antiper iodic, 
gr. xvj, equal to about §j of bark, but as much as gr. xx, and even 
more, are often required; as a general tonic y gr. j-yj. It maybe 
given dissolved in some aromatic water, by the aid of aromatic 
sulphuric acid, also as an enema, or hypodermically. (Glycerin is 
a good excipient for pills of quinine sulphate.) Saccharin will partly 
disguise the bitterness of quinine. 3^ Quininae sulphatis, gr. j ; 
saccharin, gr. v; aquae, f5j y 2 . M. S. — Shake. 

Quininae Bisulphas {Quinine Bisulphate), the normal quinine 
sulphate, is preferred only on account of its greater solubility (1 
part to 1 1 of water), as it contains about one-third less of anhydrous 
quinine than the basic sulphate. (See foot-note.) It may be given 
in the same doses as the ordinary sulphate. 

Many other salts of quinine have been introduced into prac- 
tice, but few possess any advantage over the sulphate and bisul- 
phate. 

Quininae Valerianas [Quinine Valerianate) is obtained by dis- 
solving freshly precipitated quinine in diluted valerianic acid. It 
occurs in transparent or white rhomboidal tables, of the peculiar 
repulsive odor of valerianic acid, and an acrid bitter taste, soluble in 
alcohol and ether, and soluble in water (1 to 100). It fulfills the 
indications of quinine and valerianic acid, and is therefore especially 
useful in nervous disorders. Dose, gr. j. to xx. Quinine hydro- 
bromate is official, and being soluble in 16 parts of water, is recom- 



* Therapeutical equivalents of the salts of quinine, by M. Boymond. Bull. Gen. de 
Therap., Avril I5ieme, 1887, p. 311. 

1.34 gramme of the basic sulphate = 1 gramme of anhydrous quinine. 
1. 31 " " valerianate = " " 

1.22 " a hydrochlorate = " 

1.30 " " hydrobromate = 

1.69 " " bisulphate = " ll 

Others also are given. 



TONICS. 159 

mended also for hypodermic use (Gubler). Quinine liydrochlorate 
is also official ; it is soluble in water i to 34 parts. 

Quinine sulphovinate, from its ready solubility, dissolving in 
twice its weight of water is well adapted to hypodermic injection. 

Quinine carbolate, citrate, phosphate, salicylate, and sulpho- 
carbolate have all been used of late. 

Crude quinine is the impure quinine obtained from the manu- 
facturer before separation from the insoluble impurities. It is a soft 
solid of resinous aspect, nearly free from bitterness, and may be 
given to children in the same doses as the sulphate. 

Chinoidinum { Chinoidm, qianoidht) is a "mixture of alkaloids, 
mostly amorphous, obtained as a by-product in the manufacture of 
the crystallizable alkaloids from cinchona." (U. S. P.) It appears 
as a resinous mass, variable in quality, faintly bitter, of a brownish 
color, soluble in dilute sulphuric acid and alcohol, and, according 
to Liebig, bears the same relation to ordinary quinine that uncrys- 
tallizable sugar bears to the crystallizable. It is considered equally 
efficacious with quinine, but requires doses rather larger than 
quinine sulphate, than which it is much more economical. 

Cinchoninae Sulphas (Cinchonine Sulphate} is made from the 
mother-water remaining after the crystallization of quinine sulphate. 
Being the most soluble of the phosphates of the four alkaloids found 
in bark, it remains in solution after the quinine sulphate and the 
mixed cinchonidine and quinidine sulphate have crystallized out. 
From the mother-water it is precipitated by solution of soda, then 
washed with alcohol, next re-converted into a sulphate, and boiled 
with animal charcoal to decolorize it. It occurs in short, oblique, 
shining prisms with dihedral summits, of a very bitter taste, more 
soluble in water (54 parts) than quinine sulphate, readily soluble by 
alcohol, and sparingly so by ether. It rotates polarized light to the 
right. By the addition of sulphuric acid it is converted into the 
more soluble neutral sulphate. It is now admitted to have the 
same remedial properties as quinine sulphate, but requires about 
one-third larger doses. Quinidine sulphate and cinchonidine sul- 

?* are now official; both are soluble in water 1 to 100 parts. 



* In an able article by J. Marty, entitled, " Contribution a l'etude du sulphate de 
cinchonidine envisage au point de vuephysiologique ettherapeutique," Bull. Gen. de Therap., 
cvi, pp. 395, 445, 1884, the following conclusions are drawn, viz., that its action varies 
greatly ; that occasionally therapeutic doses may prove toxic ; and that it should be used 
only in mild cases, and in doses double those of quinine. 



160 



MATERIA MEDICA AND THERAPEUTICS. 



Their effects and uses are similar to those of quinine, as a substi- 
tute for which they are much used, but the dose is somewhat 
larger. 

CORNUS. 

Cornus florida, or Dogwood {Nat. Ord. Cornaceae), is an indi- 
genous tree found in most parts of the United States, and growing 
in the Middle States to the height of from fifteen to twenty feet. 
Its flowers are remarkable for large four-leaved white or pinkish 
involucres, which appear with us in May. The official portion is 
the bark of the root. It occurs in pieces of various sizes, more or 

Fig. 15. 




CORNUS FLORIDA. INVOLUCRE. 



less rolled, and of a reddish-gray color. Its taste is bitter, astrin- 
gent, and slightly aromatic. It yields its virtues to water and 
alcohol, and contains cornin (cornic acid), resin, tannic and gallic 
acids, etc. The barks of Cornus sericea, or swamp-dogwood, and 
of Cornus circinata, or round-leaved dogwood, possess analogous 
properties. 



TONICS. 161 

Effects and Uses. — Dogwood is deservedly esteemed the best, 
substitute for cinchona among the native astringent bitters. It is 
somewhat irritant, and not unfrequently disorders the stomach. 
Dose, in powder, gr. xx to 5j ; of the fluid extract f5j or more. 

SALIX. 

The bark of Salix alba, the White Willow, and other species 
of Salix {Nat. Ord. Salicaceae), is ranked among the astringent bit- 
ters. It is little employed, however, except in the form of salicinum 
{salicin, C 13 H 18 7 , a glucoside) a neutral principle prepared from the 
bark of Salix Helix and other species of Salix, consisting of white, 
slender, silky crystals, inodorous but very bitter, soluble in water 
and alcohol, but not in ether. Salicin produces effects similar to 
those of salicylic acid (q. v.), and is employed in the same therapeu- 
tic range, especially in acute rheumatism. It renders the sweat al- 
kaline. Dose, gr. x-xx, frequently repeated. It has antiseptic and 
antifermentative properties, but is not toxic. 

PRUNUS VIRGINIANA— WILD CHERRY. 

The Wild-cherry has long been known under the name of 
Prunus Virginiana, which is still retained by the Pharmacopoeia. 
This name, however, belongs to another tree, the choke-cherry; and 
the wild-cherry is now properly distinguished as Prunus serotina 
(Nat. Ord. Rosaceae). The medicinal portion is the bark of the 
root and trunk, the former of which is the more active. It is found 
in the shops in pieces of various lengths and sizes, deprived of the 
epidermis and slightly curved, of a reddish-brown color, and a bit- 
ter, slightly astringent, aromatic taste. 

It contains a bitter y amorphous principle* (not isolated), resin, 
starch, tannic and gallic acids, a ferment-principle not identical with 
emulsin, and yields on distillation a volatile oil, containing hydro- 
cyanic acid, which does not pre-exist in the bark, but is formed by 
the reaction in water of the bitter principle and the ferment. The 
leaves also yield this oil. Boiling water impairs the virtues of the 
bark. 

Effects and Uses. — Wild-cherry bark is tonic, with some as- 
tringency, and at the same time exercises a sedative influence on 
the nervous and circulatory systems, owing to the hydrocyanic 



* Pharma. Rundschau, Sept., 1887, p. 203, " On the Constituents of Wild Cherry Bark. 
Power and Weimer. 
II 



162 MATERIA MEDIC A AND THERAPEUTICS. 

acid which is developed in it. It is used with excellent effect as a 
sedative corroborant in the various forms of pulmonary irritation, 
particularly in the latter stages of pneumonia and in the hectic of 
phthisis. It is also a useful stomachic and tonic in a variety of cases. 
The infusion (4 parts to cold water enough to make the infusion 
weigh 100 parts), is given in the dose of f§ij, twice or thrice daily. 
Of the fluid extract the dose is f5j-ij. Of the syrup, an agreeable 
and efficient preparation in the treatment of pulmonary cough, the 
dose is f Sss. 

DIGESTIVE FERMENTS. 
PEPSINUM— PEPSIN. 

In connection with the subject of stomachic tonics, this article 
is entitled to brief mention. It is prepared from the rennets either 
of the calf, sheep or pig, taken from the animal as soon as killed, 
the best process being Scheffer's. The mucous membrane of 
well-cleaned, fresh hogs 7 stomach is scraped off, chopped fine, and 
macerated for several days in water acidulated with hydrochloric acid; 
the strained and decanted clear liquid is mixed with a saturated 
solution of sodium chloride in water, and the separated pepsin after 
several hours is drained on a muslin strainer, and submitted to 
a strong pressure. Pepsin, the ferment of the gastric juice, has the 
property, at ioo° F. in an acid solution, of coagulating and dis- 
solving albuminous principles. Two grains of pepsin, with an 
ounce of distilled water and Tftv of hydrochloric acid, will dissolve 
100 grs. of coagulated white of egg at 98 F. in about four hours. 
Of saccharated pepsin, " 1 part dissolved in 500 parts of water acidu- 
lated with 7.5 parts of hydrochloric acid should digest at least 50 
parts of hard-boiled egg-albumen at ioo° F. in five or six hours." 
Since alcohol impairs the digestive property of pepsin, preparations 
of it in wine are unreliable. Acid solutions favor its action, espe- 
cially hydrochloric acid, and it may be combined with this acid if 
deficiency of the gastric juice be suspected. Glycerin is the most 
reliable agent for preserving the ferment of pepsin (Liebreich). 
The alkalies and mineral salts precipitate pepsin from solution, and 
hence are incompatible. Pepsin is now a good deal used in dys- 
pepsia, anemia and in diarrhoea, especially that which occurs in in- 
fants or children, where the stools contain undigested food. It may 
be given in doses of gr. v-xx after each meal, suspended in syrup of 
orange-peel to disguise its disagreeable taste, or taken on bread. 
Of saccharated pepsin, the dose is gr. v to xx ; of vinum pepsinae, 



TONICS. 163 

f5ss-j, an inferior preparation. Liquor pepsini is a solution of sac- 
charated pepsin (40 parts) in hydrochloric acid (12 parts), glycerin 
(400 parts), and water (548 parts) ; dose, f5j-iv. It is probably 
more efficient in cases of children than of adults. When nourish- 
ment is to be given by the rectum (as when food is rejected by the 
stomach), the addition of pepsin and a little hydrochloric acid to 
animal broths for rectal injection is highly useful. Ingluvin is a 
preparation from the gizzard of the domestic fowl ; it is an aid to 
digestion, its action depending, probably, more on the bitter-princi- 
ple which it contains, and which stimulates the gastric glands, than 
to any digestive action of the preparation itself. It is recommended 
to allay various forms of reflex vomiting, especially the vomiting of 
pregnancy. Dose, gr. v-xv. 

PANCREATINUM— PANCREATIN. 

This is obtained, by Mattison's process, from the pancreas of 
recently-killed animals, which is dissected and macerated in water 
acidulated with hydrochloric acid for about forty-eight hours, then 
separated, and the solution of pancreatin is passed through a pulp- 
filter until it is perfectly clear ; to this clear solution is then added 
a saturated solution of sodium chloride, and allowed to stand until 
the pancreatin is separated ; this is skimmed off, and placed upon a 
muslin filter and allowed to drain, after which it is washed with a 
less concentrated solution of sodium chloride, and then put under 
the press ; when all the salt solution is removed, and the mass is 
nearly dry, it is rubbed with sugar of milk, and dried without heat, 
after which it is diluted until ten grains emulsify two drachms of 
cod-liver oil. Saccharated pancreatin is employed to promote the 
digestion of fatty matters, as in asthenia and anemia, and may be 
administered in the form of emulsion, or dissolved in diluted alcohol 
or glycerin, or as a powder. As the activity of pancreatin is de- 
stroyed by acid, it should be given from 2 to 4 hours after meals. 
It is a good addition to cod-liver oil. Dose, gr. v-x. It is not 
official. 

PAPAYA. 

This is the dried juice of the half-ripe fruit of the Carica papaya 
(Nat. Ord. Papayaceae), a white, slightly astringent powder, soluble 
in water, containing the ferment papain. This principle has the 
property of digesting albuminoids and converting them into soluble 
albumen. According to Finkler, its action is that of a ferment, and 



164 MATERIA MEDICA AND THERAPEUTICS. 

not one of solution. Dr. Herschell * ascertained that it acted alike 
in acid, alkaline or neutral fluids, and that it would dissolve iooo 
times its weight of fresh blood-serum. Antiseptics, as carbolic or 
salicylic acids, do not hinder its action. It has no effect on starch 
(Martin t). It dissolves intestinal worms and the diphtheritic 
membrane. It is said not to retain its activity except in the dry 
state. Therapeutically it is employed as an aid to digestion in the 
various forms of dyspepsia, to dissolve the diphtheritic membrane y 
and as a tceniacide. Prof. Jacobi J applies it to the diphtheritic mem- 
brane in glycerin, I part to 4 ; Schaffer uses it in water, strength 5 
per cent. — both frequently applied with a brush. The dose is about 
gr. j-v, to be taken after meals in powder, aqueous solution, capsule, 
or compressed tablet. 

Further investigation and clinical experience are needed to 
place papaya on its proper therapeutical footing. 

' MINERAL TONICS. 
FERRI PR^EPARATA— PREPARATIONS OF IRON. 

The preparations of iron (Ferrum)", termed Ferruginea, Chaly- 
beates and Martial preparations, are the most important of the min- 
eral tonics. 

Incompatibles. — See each preparation. 

Aids. — Arsenic, quinine, nux vomica, gentian, beef-essence, the 
red wines, and malt-extract. 

Physiological Effects. — Besides their local tonic-astringent 
effect, and their general corroborant action on the cerebro-spinal 
system, which they possess in common with the other mineral tonics, 
they exercise a restorative influence on the composition of the 
blood, by increasing the number of its coloring particles and the 
amount of its solid constituents. Iron is in fact a natural constitu- 
ent of the blood, and is to be considered as a nutrient rather than a 
medicine. The effects of the chalybeates are best observed in con- 
ditions of the system in which there is a relative want of the red 
corpuscles of the blood. Under their use in such cases, while the 
digestive functions are promoted, the pulse becomes fuller and 
stronger, the skin assumes a healthy tint, the lips and cheeks be- 
come more florid, the temperature of the body is increased, and the 

* Brit. Med. Journ., April, 1886, p. 640. 
f Journ. of Physiol., 1885, p. 336. 
% Therap. Gaz., 1886, p. 145. 



TONICS. 165 

muscular strength is greatly invigorated. On the other hand, the 
administration of the ferruginous preparations in health, or too long 
continued, produces symptoms of plethora, vascular excitement, and 
a tendency to congestion and hemorrhage ; though it may be doubted 
whether the blood will assimilate more than the normal proportion 
of iron. The iron-salts stain the teeth a dark color, and possess an 
astringent taste. Taken with the food they assist the digestive pro- 
cess ; on an empty stomach, or when very large doses are taken, 
they irritate. 

The red corpuscles of the blood act as carriers of oxygen, which 
they take up from the inspired air in the lungs, and it is now be- 
lieved that the iron in the blood-corpuscles converts oxygen into 
ozone, a more active form of this element. Iron is an essential con- 
stituent of hemoglobin, and observation has proven that a course of 
iron in anemia increases the number of red corpuscles to double 
or treble (Rabuteau). According to Cutler and Bradford this in- 
crease does not take place in health. The state in which it exists 
in the blood-corpuscles is unknown. Absorption : from the stomach 
it is thought to be absorbed as an albuminate. Metallic iron is 
oxidized, after ingestion, by the help of water. The ferrous oxide 
and carbonate are rendered soluble by the hydrochloric acid of the 
gastric juice. Salts of the organic acids may be absorbed directly 
into the blood, the acidulous radical being burnt off and the basic 
iron remaining to combine with the red globules. Salts of the min- 
eral acids, the nitrate, chloride, and sulphate, in doses not large 
enough to constringe the tissues, are absorbed without change. 
Secretions : the astringent preparations of iron, as the chloride, sul- 
phate and nitrate, lessen the secretions generally, especially the 
gastro-intestinal. The excretion of urea is increased. The ferric 
salts possess more activity than the ferrous. Elimination : iron is 
eliminated by the bile, feces and urine. The feces are, during a 
course of iron, of a dark color, owing to the formation of ferrous 
sulphide. 

Medicinal Uses. — The diseases in which chalybeates are most 
serviceable are those which depend on a deficiency of the red cor- 
puscles of the blood, as various forms of anemia, particularly where 
this is connected with irregularity of the uterine functions, as in 
chlorosis. In these conditions it is best given in rapidly- increasing 
doses pushed until it causes headache, vertigo, fever or some gastric 
disturbance, and laxatives should be occasionally administered 



166 MATERIA MEDICA AND THERAPEUTICS. 

during a course of iron, to unload the portal circulation and relieve 
the constipation which usually ensues ; for the salts of iron 
after absorption pass directly through the liver, any unabsorbed 
portion acting as an astringent upon the gastro-intestinal canal. 
After its effects are obtained the size of the dose can be regulated 
to suit the case. When anemia is associated with gastric disturb- 
ance, the bitter tonics and acids are more serviceable than iron, 
which, however, may be given in the form of bitter wine of iron, as 
these symptoms subside. Iron is also frequently combined with 
arsenic in the treatment of anemia and chlorosis : B« Acidi arseniosi, 
gr.j; ferri reducti, gr. xxx; oleoresinse capsici, gr. v. M. S. — Ft. pil. 
no. xxx; one pill t. d., increased to five daily if the arsenic be well 
borne. By some authors* the slightly soluble preparations (iron 
filings, or reduced iron) are given at first, followed, if well borne, by 
the more soluble ones. Iron in any form does harm in chlorosis or 
anemia accompanying the early stages of phthisis. f In the manage- 
ment of anemia and chlorosis important adjuncts will be found in 
rare meats, rich broths and suitable stimulation Iron is also useful 
in scrofula, tuberculosis, degeneration of the viscera, and cachectic 
states of the system, characterized by paleness of the lips, face and 
conjunctivae. Many forms of nervous disorders, as neuralgia, chorea, 
hysteria and epilepsy, are very decidedly controlled by the prepara- 
tions of iron, and they probably constitute the best remedies in these 
affections, when attended with anemia. Several of the preparations 
of iron are also much employed both as stomachics and astringents. 

The following are the official preparations of iron, which are 
needlessly multiplied in the U. S. P.: — 

Ferrum Reductum {Reduced Iron). Metallic iron is obtained 
for medicinal purposes in the form of an impalpable powder by 
reducing the ferric hydrate by passing a stream of hydrogen gas 
over it. It is a light, tasteless, iron-gray powder, insoluble in water, 
but completely soluble in diluted sulphuric acid, and it should be 
kept in a well-stoppered bottle, owing to its great liability to 
oxidation. This preparation, sometimes called Queue tine's Iron, 
is a mild chalybeate, and is a favorite prescription with many 
practitioners in the treatment of chlorosis and other varieties of 
anemia. Dose, gr. v to x, three times a day, after meals, in the 



* Trousseau et Pidoux, 9th ed., Vol. 1, 1880, p. 5. 
f Ibid., p. 7. 



TONICS. 167 

form of pill made with sugar and gum; or it may be swallowed 
readily in a bolus of soft bread. It is sometimes prepared with 
chocolate in the form of lozenges. It is well adapted to prolonged 
use. 

Ferri Oxidum Hydratum (Hydrated Ferric Oxide). This 
preparation (ferric hydrate) (Fe 2 6HO) is made by precipitating the 
ferric hydrate from its combination in any ferric salt (officially, 
ferric sulphate) by means of ammonia. When dry, it is a reddish- 
brown powder, and it is not an eligible preparation for medicinal 
use. It is furnished in the form of a freshly-precipitated, soft, 
moist, reddish-brown magma for use as an antidote to arsenious acid. 

Ferri Oxidum Hydratum Cum Magnesia (Hydrated Ferric 
Oxide with Magnesia). In this preparation ferric hydrate is pre- 
cipitated by means of magnesia, instead of ammonia. It is readily 
prepared, and is used as an antidote to arsenious acid. It is to be 
preferred to the ordinary hydrate, because the magnesia by its 
purgative action aids in the removal of any of the poison which may 
remain after the action of emetics or the use of the stomach pump, 

Ferri Carbonas Saccharatus (Saccharated Ferrous Carbonate) 
is obtained by the double reaction of ferrous sulphate and sodium 
bicarbonate, and is protected from oxidation by the addition of 
sugar. It is a greenish-gray powder, oxidizing slowly in the air, 
only partially soluble in water, but completely soluble in hydro- 
chloric acid. It is a valuable preparation, particularly adapted to 
cases of weak digestion as in anorexia and asthenia , when iron is 
indicated. Dose, gr. v-xxx. 

Trochisci Ferri (Troches of Iron) are made with ferric hydrate, 
vanilla, sugar and mucilage of tragacanth; each lozenge contains of 
the iron gr. v. 

Empiastrum Ferri (Plaster of Iron) is made with ferric hydrate, 
lead-plaster, Burgundy pitch, and Canada turpentine. 

Massa Ferri Carbonatis (Fill of Ferrous Carbonate) — Vallefs 
Ferruginous Mass. To protect the ferrous carbonate (FeC0 3 ) from 
oxidation, it is prepared (as in the process last described) by dissolv- 
ing the reacting salts in weak syrup instead of water; honey and 
sugar being afterward added to preserve it unaltered and bring it to 
the pilular consistence. This preparation is one of the most popular 
of the chalybeates. It contains nearly half its weight of ferrous 
carbonate. From gr. v-xx of the pilular mass may be taken in 
divided doses through the day. 



168 MATERIA MEDICA AND THERAPEUTICS. 

Mistura Ferri Composita {Compotind Iron-Mixture) {Griffith's 
anti-hectic mixture) is a mixture of ferrous sulphate and potassium 
carbonate with myrrh, spirit of lavender, rose-water and sugar, to 
resist oxidation. It is a favorite chalybeate in chlorosis and 
amenorrhoea. Dose, fSj to ij, t. d. 

Pilulee Ferri Compositae {Compound Iron-Pills) are prepared 
with sodium carbonate and ferrous sulphate with myrrh and syrup. 
Dose, from two to six pills three times a day. Both these prepara- 
tions should be made only as wanted for use. 

Ferri Sulphas {Ferrous Sulphate) (FeS0 4 .7H 2 0), known, in its 
impure state, as green vitriol or copperas, is prepared for medicinal 
use by dissolving iron-wire in diluted sulphuric acid, with heat. It 
occurs in transparent, pale bluish-green crystals, of the form of 
oblique rhombic prisms, of an acrid, styptic taste, soluble in water, 
but insoluble in alcohol. By exposure to the air they effloresce, 
absorb oxygen, and become yellowish- white, from the formation of 
ferric sulphate. When heated to 239 , they give out six of their 
seven equivalents of water, and are converted into a grayish-white 
mass known as the dried sulphate. The alkalies and alkaline earths 
and their carbonates, silver nitrate, and lead acetate, are incompati- 
ble with this salt. Ferrous sulphate is one of the most active of 
the ferruginous preparations, but its local effects are powerfully 
astringent, and in a concentrated form it acts as an irritant poison. 
It is preferred to other chalybeates where there is much relaxation 
of the solids, with excessive discharges ; but it is not so well adapted 
to long-continued use, on account of its local irritant action. 
Topically, it is employed in substance and solution as a styptic and 
astringent. Dose, gr. j-v, in pill ; of the dried sulphate {ferri sulphas 
exsiccatus), gr. ss-iij. A good tonic-combination is ^ Ferri 
sulphatis exsiccati, gr. j ; extracti nucis vomicae, gr. j4 ', extracti 
gentianae, gr. ij. M. S. Ft. pil. No. 1 ; one pill 3 or 4 times daily. 
Ferrous sulphate is also used as a disinfectant, dissolved in water, 
(Bbj to Oviij) to cleanse privies, drains, etc., under the name of 
copperas. 

Ferri Sulphas Praecipitatus {Precipitated Ferrous Sulphate). 
In this preparation the ferrous sulphate is precipitated from an 
aqueous solution by alcohol. Dose, gr. j-v. 

Liquor Ferri Tersulphatis [Solution of Iron Ter sulphate) (Fe 2 3S0 4 ). 
This preparation is made by dissolving ferrous sulphate in a mix- 
ture of sulphuric and of nitric acids, with water. The nitric acid 



TONICS. 169 

furnishes oxygen, which converts the iron from a ferrous to a ferric 
condition. It is a solution of the normal ferric sulphate. This 
solution is a clear, reddish-brown liquid, nearly devoid of odor, and 
of a sour, very styptic, and somewhat acrid taste. Its chief use 
is in making ferric hydrate, and it should be kept on hand for the 
preparation of the antidote for arsenious acid. It may be used 
as a styptic, but for this purpose it is inferior to the next prepar- 
ation. 

Liquor Perri Subsulphatis {Solution of Iron Subsulphate) 
(MonseVs Solution} is made in the same way as the last prepa- 
ration, except that only half the amount of sulphuric acid is used, 
and a basic ferric sulphate results (Fe 4 0sS0 4 ). It has a syrupy 
consistence, a ruby-red color, is inodorous, and has a very astring- 
ent but not acrid taste. This is a solution of the basic ferric sulphate, 
and is less irritant than that of the normal ferric sulphate. It may 
be used internally, in hemorrhage from the stomach and bowels, in 
the dose of from Tftv-xv. Externally, it is one of the most efficacious 
styptics we can employ; and has been injected into ncevi with 
success, and applied by means of the atomizer, and has been found 
efficient in hemoptysis. Diluted with water, it is a good local 
application to inflamed mucous surfaces. Cotton saturated with 
Monsel's solution (styptic cotton) and dried, may be pressed firmly 
into a wound to arrest capillary oozing, and introduced within the 
nose to stop epistaxis. 

Ferri Chloridum (Ferric Chloride) (Fe 2 Cl 6 .i2H 2 0) is made 
by heating iron-wire with hydrochloric acid (by which ferrous 
chloride is formed), and afterward converting the ferrous into ferric 
chloride by heating it with hydrochloric and nitric acids. It 
occurs in fragments of a crystalline structure, an orange-yellow 
color, inodorous, of a strong chalybeate, styptic taste, deliquescent, 
and wholly soluble in water, alcohol and ether. Internally, it is 
used chiefly in the form of the tincture. Externally ; it is applied as 
a styptic, and in solution, of various strengths, as an astringent. 
One part, gradually added to six parts of collodion, forms a yellow- 
ish-red, limpid liquid, of valuable styptic properties. 

Liquor Ferri Chloridi (Solution of Ferric Chloride) is prepared 
by dissolving iron-wire in hydrochloric acid, heating to the boiling 
point, then heating the liquid, after filtration, with hydrochloric and 
nitric acids, and afterward adding distilled water. A reddish-brown 
liquid, having an acid and strongly styptic taste, and sp. gr. 1.405. 



170 MATERIA MEDIC A AND THERAPELTICS. 

It may be used internally for the purposes of the chloride, in doses 
of TTUj-vj, diluted, and externally as a styptic. 

Tinctura Ferri Chloridi {Tincture of Ferric Chloride) is made 
by mixing 35 parts of solution of ferric chloride with 65 parts of 
alcohol. It is a tincture of the chloride, though there is probably 
some reaction between the acid and the alcohol, as the preparation 
has an ethereal odor. It is of a reddish-brown color, and has a sour, 
styptic taste. It is one of the most effective of the chalybeates, 
acting locally as an energetic astringent and styptic, and, in large 
doses, as an irritant. Its indications, both general and topical, are 
very analogous to those of the sulphate, and it is the preparation of iron 
usually employ ed internally . It is especially useful in anemia^ erysipelas, 
septicemia and pyemia, ascites, cerebral anemia, rheumatic arthritis and 
hypochondriasis , where there is evident deficiency of red coloring 
matter in the blood. It is also often serviceable in angina pectoris 
(attack), as a tonic in emphysema, cardiac dilatation, hemiplegia and 
paralysis agitans. Dose, Vflx to xxx, which may even be gradually 
increased to f5j, in certain diseases (as erysipelas). Tincture of 
ferric chloride is decomposed by the alkalies, alkaline earths, and 
their carbonates ; also by vegetable infusions containing tannin and 
mucilago acaciae, which throw down a brownish, partly trans- 
parent, jelly-like mass, and which are accordingly incompatible 
with it. It should be taken well diluted after eating, and through 
a glass-tube to avoid injury to the teeth. Attention has been called 
by Prof. T. D. Reed* to the addition of potassium citrate in pre- 
scribing tincture of ferric chloride, which forms with it (probably 
ferric citro-chloride) a clear, light-green solution, possessing similar 
ferruginous properties, free from the roughness of the iron, and 
compatible with the astringents and bitters. B* Tincturi ferri chlo- 
ridi, f5ij ; potassii citratis, 5j ; syrupus limonis, fSjss ; aquae, ad f§vj. 
M. S. — One tablespoonful represents Tftx of the iron — an elegant 
preparation. This combination may be prescribed with the salicy- 
lates which are otherwise incompatible with iron. 

Mistura Ferri et Ammonii Acetatis (Mixture of Iron and 
Ammonium Acetate) (Bashairis Mixture) is made with tincture of 
ferric chloride, diluted acetic acid, solution of ammonium acetate, 
elixir of orange, syrup and water. By the reaction of the ferric 
chloride and ammonium acetate, ferric acetate and ammonium chlo- 

* Canada Med. and Surg. Journ., August, 1881, p. 7. 



TONICS. 171 

ride are formed. A most excellent preparation, and of great benefit 
in chronic albuminuria, and in chronic dropsies generally where iron 
is indicated. Dose, fSss-j. It forms with quinine an acetate of the 
alkaloid. 

Ferri Iodidum Saccharatum (Saccharated Ferrous Iodide). 
This salt is made by the addition of iron-filings to a mixture of 
iodine in distilled water, and sugar of milk is added to prevent oxi- 
dation. By evaporation a yellowish-white or grayish powder is 
obtained, of a sweetish, ferruginous taste, deliquescent, and very 
soluble in water. Dose gr. x-xxx. 

Syrupus Ferri Iodidi [Syrup of Ferrous Iodide), which is pre- 
pared by mixing iodine and iron-wire in distilled water, and shaking 
the mixture until the solution has acquired a green color, adding 
syrup, heating to 212°, straining, and, when the liquid has cooled, 
adding distilled water. It must be kept in well-stoppered vials. It 
is a transparent liquid, of a pale-green color, and furnishes an excel- 
lent alterative tonic, combining the effects of iodine and of iron, and 
is particularly applicable to the treatment of scrofula, rickets, and 
phthisis. It is incompatible with the alkalies, their carbonates, and 
tannin : with potassium chlorate a dangerous reaction takes place, 
free iodine being liberated. Dose, TTlv-f5j. 

Pilulae Ferri Iodidi (Pills of Ferrous Iodide) are made with iodine, 
reduced iron, sugar, acacia, glycyrrhiza, extract of glycyrrhiza, and 
an ethereal solution of balsam oftolu. They keep very well. Each 
pill contains about gr.j of ferrous iodide and gr. J^ of reduced iron. 

Ferri et Potassii Tartras [Iron and Potassium Tartrate) is pre- 
pared by the addition of ferric hydrate to a mixture of potassium 
bitartrate in distilled water. It occurs in transparent scales of a 
ruby-red color, which are wholly soluble in water. The tartaric acid 
and potash, in combination in this preparation, render it less con- 
stipating than the other chalybeates ; and, from its agreeable taste, it 
is adapted to the diseases of childhood. It is, moreover, not incom- 
patible with the alkalies. Dose, gr. x-5ss. 

Ferri Phosphas {Ferric Phosphate} is obtained by the double 
reaction of solutions of ferric citrate and sodium phosphate and 
evaporating to dryness. It occurs in bright-green transparent 
scales, insoluble in alcohol, but soluble in water ; by exposure to 
the light it becomes darker. According to Rother* it is a combi- 
nation of ferric phosphate and sodic citrate. Dose, gr. v-x, in pill. 

% Am. Jour. Pharm., 1876, p. 171, and 1883, P- I ^3- 



172 MATERIA MEDIC A AND THERAPEUTICS. 

Ferri Pyrophosphas [Ferric Pyrophosphate) (Fe 4 3P 2 7 .9H 2 0). 
It occurs in apple-green scales, of an acid, slightly saline taste, and 
is very soluble in water. A good chalybeate. Dose, gr. ij-v. Given 
also as a syrup. 

Ferri Hypophosphis {Ferric Hypophosphite) (Fe 2 6H 2 P0 2 ) is 
obtained by the reaction of a solution of sodium or ammonium 
hypophosphite with a solution of ferric sulphate. It is a white, 
amorphous powder, insoluble in cold water, soluble in hydrochloric 
acid, incompatible with the soluble salts of mercury and silver, but 
has the advantage of not being decomposed by the cincho-tannic 
acid of cinchona. This is a good chalybeate in diseases of de- 
generation of the nervous tissue, and has been (also given in 
phthisis ; other hypophosphites are combined with it. Dose, gr. 
x-xxx, t. d. 

Ferri Citras [Ferric Citrate} (Fe 2 2C 6 H 5 7 .6H 2 0) is prepared 
by the addition of ferric hydrate to a solution of citric acid, and 
occurs in thin, transparent pieces, of a garnet-red color, with a mild, 
acid, chalybeate taste, slowly soluble in- cold water, but readily solu- 
ble in boiling water. Dose, gr. v-x. It is official also in the form 
of Liquor Ferri Citratis (Solution of Ferric Citrate), a deep reddish- 
brown liquid, given in doses of gtt. x-xx ; and it is by evaporating 
this solution that the solid citrate is obtained. 

Liquor Ferri Nitratis [Solution of Ferric Nitrate) (Fe 2 6N0 3 ) 
is prepared by the gradual addition of diluted nitric acid to ferric 
hydrate. It is a pale, amber-colored liquid, with a strong, astringent 
acid taste. It is tonic and astringent, agreeing very well with the 
stomach, and is employed in the treatment of chronic diarrhcea, 
hematemesis, hemorrhage from the bowels, hematuria and uterine 
hemorrhage, particularly when anemic symptoms are present. Dose, 
gtt. x-xx, t. d., in dilution. 

Syrupus Ferri Bromidi [Syrup of Ferrous Bromide) contains 
io per cent, of ferrous bromide. It may be given with advantage 
where a bromide and iron are both indicated, notably in chorea 
occurring in delicate girls at the age of puberty, and associated with 
anemia. Dose, f5j. 

Ferri Oxalas [Ferrous Oxalate) (FeC 2 4 .H 2 0) is made by the 
reaction of solutions of oxalic acid and ferrous sulphate. It occurs 
as a lemon-yellow, crystalline powder, almost destitute of taste, 
slightly soluble in water, but easily acted upon by the diluted acids, 
and decomposed by the alkalies and their carbonates. This chaly- 



TOAICS. 173 

beate has the advantage of being well borne by the stomach, and 
of being readily absorbed, while it is nearly destitute of astringency, 
and not disposed to change like the ferrous salts generally. Dose, 
gr. ij-iij, in pill, t. d. 

Liquor Ferri Acetatis (Solution of Ferric Acetate). Dose, 
fltx-xxx. Chiefly used in preparing 

Tinctura Ferri Acetatis [Tincture of Ferric Acetate), a solu- 
tion of ferric acetate in alcohol and acetic ether. Dose, 1TLx-f5ss, 
or more. 

Ferri Lactas [Ferrous Lactate) is made by mixing diluted 
lactic acid with iron-filings. It occurs in greenish-white crystalline 
crusts or grains of a mild, sweetish, ferruginous taste, sparingly 
soluble in water, and insoluble in alcohol. Used in chlorosis it has 
a marked effect in increasing the appetite. Dose, gr. x-xx, m pill, 
lozenge or syrup. 

Ferri et Quininae Citras {Iron and Quinine Citrate). This salt 
is prepared by dissolving quinine in a hot solution of iron citrate 
and evaporating the solution. As found in the shops, it is a mechani- 
cal mixture of ferric citrate with a variable proportion of iron and 
quinine citrate. It occurs in thin, transparent scales, of a reddish or 
yellowish-brown color, with a tint of green, not very soluble in 
water, and of a ferruginous, moderately bitter taste. It combines 
the virtues of its two bases, and is thought to have an especial 
agency in diminishing the formation of urea, whence its use in 
uremia. Dose, gr. v-x. 

Liquor Ferri et Quininae Citratis [Solution of Iron and Quinine 
Citrate). Dose, f5j. 

Vinum Ferri Amarum {Bitter Wine of Iron) is a mixture of solu- 
tion of iron and quinine citrate, tincture of sweet orange-peel, syrup 
and stronger white wine. Dose, f5j-ij. 

Ferri et Ammonii Citras {Iron and Ammonium Citrate) is made 
by adding water of ammonia to solution of iron citrate, and evapor- 
ating. It occurs in the form of garnet-red translucent scales, of a 
slightly ferruginous taste, and is readily soluble in water ; it has 
antacid properties. Dose, gr. v-x. 

Vinum Ferri Citratis {Wine of Citrate of Iron), a solution of 
ammonio-ferric citrate in tincture of sweet orange-peel, syrup and 
stronger white wine. Dose, f3j. 

Ferri et Strychninae Citras {Iron and Strychnine Citrate) is made 
by mixing a solution of strychnine and citric acid in distilled water 



174 MATERIA MEDICA AND THERAPEUTICS. 

with a solution of iron and ammonium citrate in water and evapor- 
ating. It occurs in garnet-red scales, of a bitter, ferruginous taste, 
readily soluble in water. An excellent tonic. Dose, gr. ij-iij, t. d. 

Syrupus Ferri, Quininee et Strychninae Phosphatum {Syrup of 
Iron, Quinine and Strychnine Phosphates), an agreeable tonic. 
Dose, f5j. 

Ferri et Ammonii Sulphas [Iron and Ammonium Sulphate, 
(NH 4 ) 2 Fe 2 (S0 4 ) 4 .24.H 2 0). This salt, called also ammonio-ferric alum, 
is made by adding ammonium sulphate to a hot solution of ferric 
sulphate. It occurs in octahedral crystals, of a pale-violet color 
and sour, astringent taste, efflorescent, and very soluble in water. 
Used in diarrhoea and chronic dysentery. Dose, gr. v-xv, two or 
three times a day. 

Ferri et Ammonii Tartras {Iron and Ammonium Tartrate) 
(2(FeO)NH 4 C 4 H 4 6 .5H 2 0) occurs in transparent, garnet-red scales, 
of a sweetish taste, soluble in water, insoluble in alcohol and ether. 
A mild chalybeate. Dose, gr. x-xxx. 

Ferri Valerianas {Ferric Valerianate)^ d. dark, tile-red, amorphous, 
unstable powder,* with a mildly styptic taste and an odor of valeri- 
anic acid ; insoluble in cold water, but readily soluble in alcohol. 
Dose, gr. j-iij. 

Ferrum Dialysatum {Dialyzed Iron) has been introduced as a 
substitute for the tincture of ferric chloride, than which it is much 
less efficacious. It is not apt to constipate, is almost tasteless, and 
may be given in doses of from gtt. xv-1 daily. Dialyzed iron is an 
antidote to arsenic in the stomach. To ensure its conversion into 
ferric hydrate in the stomach, its ingestion should be followed by a 
tablespoonful of sodium chloride. It is not official. 

Pills of aloes and iron, and syrup of the hypo phosphites with iron 
are also official. 

CHALYBEATE WATERS— NORTH AMERICA. 

Schooley's Mountain Springs {Morris County, New Jersey), 
Analysis by C. Mclntire, Jr. One pint contains a small proportion 
of the sodium, magnesium, manganesium, calcium and iron carbon- 
ates with carbonic acid gas. 

Cresson Springs {Cambria County, Pennsylvania). Analysis by 
F. A. Genth. There are three springs, viz., the Iron, Alum and 

* Arch, de Neurol., xix, 1890, p. 239. Valerian et ses preparations, par Yvon. 



TONICS. 175 

Magnesia. The Iron contains nearly gr. ]/ 2 of the carbonate and gr. 
iij of ferrous sulphate to the pint, besides the earthy and alkaline car- 
bonates, chlorides, etc. 

Rawley Springs {Rockingham County, Virginia). Analysis by 
Prof. J. W. Mallet. One pint contains iron carbonate gr. \ besides 
the magnesium, calcium, and manganesium carbonates. 

New Almaden Vichy [Santa Clara County, California). One 
U. S. gallon contains gr. 5 of iron carbonate with sodium bicarbon- 
ate gr. 201, and chloride gr. 33, and Epsom salt gr. 12; also 238 
cub. in. of free carbonic acid gas. 

The Sharon Chalybeate Spring (New York) contains iron sul- 
phate gr. 24 to the U. S. gallon ; Schuyler Chalybeate Spring (New 
York) iron sulphate gr. 70 to the U. S. gallon ; Thorp's Spring (Hood 
County, Texas) iron carbonate gr, 40 to the U. S. gallon. 

CHALYBEATE WATERS— EUROPE. 

Schwalbach and Pyrmont (Germany) ; Spa (Belgium), and Saint 
Moritz (Switzerland). The first named contains almost gr. x / 2 of 
iron carbonate to the pint, a large quantity of carbonic acid and a 
few other mineral ingredients ; in Pyrmont is found about gr. J^ of 
iron carbonate to the pint, and also a large proportion of calcium 
sulphate and other salts, so that it is not a pure chalybeate. The 
waters of Spa are almost purely chalybeate, containing gr. 2 /^ °f 
iron carbonate to the pint and much carbonic acid gas. The Saint 
Montz yields about gr. \ of iron carbonate to the pint and it is 
therefore a fair ferruginous water. 

The waters of this class, which owe their virtues to the pres- 
ence of iron in the form of bicarbonate or sulphate kept in solution 
by carbonic acid gas, are mostly limpid and colorless. If the iron 
be present in large quantity their taste is astringent. They produce 
effects similar to the official preparations of iron, with the additional 
advantage of change of life, scene and climate, which is conferred 
by a sojourn at these springs. The iron waters are indicated in 
anemia and chlorosis, and in cases generally suited to the iron- 
preparations. 

MANGANI PR^PARATA— PREPARATIONS OF MANGANESE. 

Manganese (Mn) is a normal constituent of the body, existing 
in small amounts in the blood, hair, bile, etc. When given inter- 
nally in small doses the appetite improves, the digestive functions 



176 MATERIA MEDICA AND THERAPEUTICS. 

are promoted and the body gains in weight; these effects are sup- 
posed to be most conspicuous in conditions due to an insufficiency 
of iron, and probably of manganese, in the blood. If a large dose 
be taken the cardiac action is depressed and the blood-pressure 
lowered. After a toxic dose violent gastro-enteritis ensues. Injected 
into the blood, or given hypodermically, the salts of manganese 
paralyze voluntary motion and reflex action and arrest the heart in 
diastole. They have been used as substitutes for, or combined 
with, the iron salts, in anemia, chlorosis, and cachectic states, but are 
inferior to the latter remedies. 

The following are the official preparations : — 

Mangani Oxidum Nigrum {Manganese Black Oxide) is the 
" native, crude Manganese Binoxide, containing at least 66 per cent, 
of the pure oxide (Mn0 2 )." It is a heavy, grayish-black, amor- 
phous or crystalline powder, odorless, tasteless and insoluble in 
water or alcohol. It has been used as a substitute for iron in the 
above-mentioned diseases and as a substitute for bismuth in gastro- 
dynia and pyrosis. Dose, gr. j-x in pill, capsule or powder. 

Mangani Sulphas [Manganese Sulphate) (MnS0 4 4H 2 0) occurs 
in transparent and colorless or pale rose-colored crystals, slightly 
efflorescent in dry air; without odor, but having a faintly bitter, 
astringent taste ; soluble in water but not in alcohol. Its effects 
are those as above stated, and it is much more active than the 
black oxide. It is believed, also, to act as a cholagogue, and it has 
been used for this purpose in jaundice, especially when due to 
catarrh of the biliary ducts. It has also been used as a substitute 
for iron. Dose, gr. ij-v. 

Potassium Permanganate is considered among the antiseptics, 
q. v. 

ACIDA MINER ALIA— MINERAL ACIDS. 

Incompatibles. — Nitric, nitro-hydrochloric and hydrochloric 
acids being powerful oxidizing agents form explosive compounds 
with readily oxidizable substances as the carbohydrates, alcohols, 
ethers, sulphur, phosphorus and the sulphides. The mineral acids 
are incompatible with the salts of lime, lead, silver, the carbonates, 
and hydrates, and they liberate the weaker acids in combination, 
and decompose the glucosides. 

Aids. — The tonics, bitters and pepsin, the latter with HC1. 

Physiological Effects. — The diluted mineral acids are usually 
classed with tonics; but, although they exert a very considerable 



TONICS. 177 

corroborant influence on the system, their action is in many respects 
peculiar and distinctive. In the concentrated form they are corro- 
sive. When properly diluted with water and swallowed in medi- 
cinal doses, they allay thirst, increase the appetite, stimulate diges- 
tion, increase the flow of bile by duodenal irritation, and all possess 
great diffusive power. After absorption into the blood, they com- 
bine either with its alkaline bases or albumen, and often produce a 
restorative effect in morbid conditions of the circulating fluid, and 
in their passage out by the secretions act as astringents. Accord- 
ing to Gubler, the mineral acids exist in the blood loosely combined 
with albumen, and by the action -of the excretory organs this com- 
bination is broken up, the albumen remaining in the vessels, the 
acid passing out united with other bases. Acids given on an 
empty stomach check the secretion of the acid gastric juice ; given 
on a full stomach they render its contents more acid; hence, if 
there be an excess of acid secreted by the stomach, they should 
be exhibited before meals, in small doses and well diluted ; while 
if there be too little acid secreted, they may be given after meals 
to supply the deficiency. They are employed — as tonics, usually 
in combination with the vegetable bitters, in dyspepsia, especially 
where it is dependent on a deficiency of the gastric fluid, in typhoid 
and other essential fevers, in purpura and in scurvy ; as astringents 
and styptics, in hemorrhage from the stomach and bowels, and in 
colliquative sweats and diarrhoea; to allay febrile heat and cutaneous 
irritation; in phosphatic lithiasis ; and locally, as escharotics; and 
in very dilute solutions they are injected into the bladder as 
lithontriptics. In cases of poisoning from the mineral acids the 
proper antidotes are the alkalies or the alkaline earths to neutralize 
the acid and thus render it inert, and the free use of the fixed oils 
or albumen to protect the surface of the alimentary tract. 

Acidum Sulphuricum {Sulphuric Acid) (H 2 S0 4 ), formerly called 
Oil of Vitriol, is obtained by burning sulphur, mixed with nitre, over 
a stratum of water contained in a chamber lined with sheet-lead. 
It is a dense, colorless, inodorous, corrosive liquid, of a strongly 
acfd taste and an oily consistence, which unites with water in all 
proportions with the evolution of heat. Its sp. gr. should not be 
lower than 1.840. It should contain not less than 96 per cent, of 
absolute sulphuric acid, and not more than 4 per cent, of water. 
The diluted acid is readily detected by a soluble barium salt, which 
precipitates a white insoluble barium sulphate; veratrine introduced 
12 



178 MATERIA MEDICA AND THERAPEUTICS. 

into the diluted acid, and evaporated to dryness, leaves a crimson 
deposit. In the concentrated form it is not employed internally, 
but is sometimes used externally as a caustic, acting by coagulat- 
ing albumen, and its affinity for water and the organic bases. 
When swallowed, it acts as a violent corrosive poison, causing a 
burning pain in the mouth, throat and stomach, and usually stain- 
ing the lips, mouth and fauces with black sloughs; occasionally the 
action of the poison is spent upon the upper part of the larynx, 
and death takes place from asphyxia, without the entrance of the 
poison into the stomach. The chemical antidotes are magnesia, 
chalk, the alkalies or solution of soap, and mucilaginous drinks 
should be afterward freely administered. 

Acidum Sulphuricum Dilutum (Diluted Sidphuric Acid) contains 
one part of sulphuric acid and 9 parts of distilled water. It there- 
fore contains 10 per cent, of the official (not the absolute) sulphuric 
acid. Diluted sulphuric acid lessens thirst, aids digestion, and 
diminishes the secretions of the bowels and skin. It is given as a 
tonic, refrigerant and astringent, in the dose of from gtt. x-xxx, t. 
d., in water, and should be sucked through a tube to prevent injury 
to the teeth. This acid is a particularly valuable remedy in typhus 
and typhoid fevers, colliquative sweats, cholera and choleraic diar- 
rhoea; and it is the best corrective for pliospliatic lithiasis. It is 
used externally as a gargle and a wash to ulcers. 

It may be taken in the natural form since the water of the Oak - 
Orchard Acid Spring of Genesee County, New York, yields gr. 
x, of free sulphuric acid to the pint and is well adapted to prolonged 
use as in phosphatic lithiasis. 

Acidum Sulphuricum Aromaticum (Aromatic Sidphuric Acid), 
or Elixir of Vitriol, is made by adding 200 parts of sulphuric acid to 
700 parts of alcohol and allowing the mixture to cool, then add 45 
parts of tincture of ginger and 1 part of oil of cinnamon, with sufficient 
alcohol to make the product weigh 1000 parts. It is a reddish- 
brown liquid, with an aromatic odor and a pleasant acid taste; and 
is an agreeable substitute for the diluted sulphuric acid, adminis- 
tered in the same doses. 

Acidum Nitricum (Nitric Acid) (HN0 3 ) is obtained by the 
action of sulphuric acid upon potassium nitrate. When pure it is 
colorless; but as found in the shops it is usually of a straw-color, 
owing to the presence of nitric peroxide. It should have a sp. gr. 
1.420 and contain 69.4 per cent, of anhydrous acid. It is a corro- 



TONICS. 179 

sive, sour liquid, evolving white fumes when exposed to the air. It 
may be recognized by giving off dense red fumes when added to cop- 
per-turnings, by the morphine test (see morphina), and by striking 
a blood-red color, changing to yellow in minute quantity, with solu- 
tion of sulphuric acid and brucine. Nitric acid is readily absorbed 
by the blood, and probably exists there either in the form of nitrates 
or combined with albumen (Gubler). Nitric acid stimulates the 
glandular apparatus of the intestinal canal, apparently due to a local 
action. It is probably eliminated as a nitrate by the kidneys. Lo- 
cally, nitric acid is a powerful caustic, acting by abstracting water 
and combining with the alkaline bases of the tissues. It is em- 
ployed, in the concentrated form, as an escharotic to destroy warts 
and stimulate indolent sinuses, and diluted, as an astringent wash or 
gargle. Atthill * applies the fuming nitric acid within the uterus suc- 
cessfully, in the treatment of Menorrhagia due to granulations of the 
mucous membrane, in hemorrhage after the removal of a polyp, and 
in endometritis, on cotton wrapped round copper-wire or a catheter, 
the cervix being protracted by a vulcanite tube. He states that 
applied in this way it seldom causes pain. It is also applied to the 
pustules of acne, and as a cauterant to ncevi, phagade?ia, and rodent 
ulcer. Cases of poisoning from this acid are to be treated with 
magnesia, the alkalies, or soap, and mucilaginous drinks. In poi- 
soning from nitric acid, the fauces and mouth are covered with yel- 
low eschars, due to the formation of picric acid. Internally, it is 
used in the form of — 

Acidum Nitricum Dilutum {Diluted Nitric Acid), which contains 
one part of nitric acid and six parts of water, by weight; or 10 per 
cent, of absolute acid. This is given as a substitute for sulphuric 
acid. Dose for internal use Tfljj-xx, t. d., reduced with water. 

Acidum Hydrochloricum [Hydrochloric Acid — Muriatic Acid) is 
an aqueous solution of hydrochloric acid gas (HC1), of sp. gr. 1.160, 
and is obtained by the action of sulphuric acid on a solution of so- 
dium chloride. The official acid is composed of 31.9 per cent, of 
absolute hydrochloric acid, and 68.1 per cent, of water. It is, 
when pure, a transparent, colorless liquid, but has often a yellow 
color, owing to the presence of chlorine, iron, or other contamina- 
tion. It gives off dense white fumes when in contact with ammo- 
nia, and evolves chlorine gas when heated with manganese dioxide ; 

* " Clinical Lectures on Diseases Peculiar to Women," 1883, pp. 104, 199, 378. 



180 MATERIA MEDICA AND THERAPEUTICS. 

in the diluted state it produces, with solution of silver nitrate, a 
white precipitate, insoluble in boiling nitric acid, but soluble in am- 
monia. Locally, it is an active caustic, abstracting water and uniting 
with the alkaline bases of the tissues. Strong baths of hydrochloric 
and other mineral acids exert a powerful influence upon the skin. 
Hydrochloric acid is readily absorbed by the stomach, either as a 
chloride or joined with albumen. Hydrochloric acid, in small 
quantities, augments the digestive power of the gastric juice, and, 
probably, exists normally in that fluid. Hydrochloric acid is chiefly 
eliminated by the urine. It has a corrosive taste and a suffocating 
odor, and is an active poison, though less irritating than sulphuric 
and nitric acids. A poisonous dose produces blackness of the lips, 
redness of the tongue, difficulty in swallowing, and violent gastric 
pain. Magnesia, soap, or the alkalies are the chemical antidotes : 
afterward mucilaginous drinks should be given. It is used exter- 
nally as a caustic, and as an application in diphtheria, ulcerative 
and gangrenous stomatitis, and, internally, in the form of 

Acidum Hydrochloricum Dilutum (Diluted Hydrochloric Acid- — 
Diluted Muriatic Acid), which contains 6 parts of the official acid and 
13 parts of water, by weight; or 10 per cent, of the absolute acid. 
This is employed in typhoid and typhus fevers ; also to counteract 
phosphatic deposits in the urine, and in dysentery. In gastric dys- 
pepsia attended with deficiency of the gastric juice, since it exists 
probably normally* in this fluid, it is useful, especially when com- 
bined with pepsin ; the liquor pepsini, as it contains both remedies^ 
is an eligible preparation in this condition and should be taken after 
meals. Dose, tltv-xx, which may be given in infusion of rose. 

Acidum Nitro-Hydrochloricum (Nitro-Hydrochloric Acid — Nitro- 
Muriatic Acid). This acid is made by mixing 4 parts of nitric 
acid with 15 parts of hydrochloric acid, the resulting reaction 
liberating chlorine, and forming chloronitrous acid and water, as 
follows : HNO3 + 3HC1=C1 2 +NOC1 (chloronitrous acid) + 2H 2 0. 
It has a deep golden-yellow color, and emits the smell of chlorine, 
which is the chief active constituent. Internally, it is employed as 
a stomachic tonic, and is thought also to be particularly efficacious 
in oxaluria, and diseases of the liver, as jaundice due to catarrh of 
the bile ducts. Rutherford's experiments on dogs show that it is an 
hepatic stimulant. It should not be given with mercurials. Exter- 

*" Human Physiology," 1887. p. 139. Chapman. 



TONICS. 181 

nally, it is used as a bath, either local or general, in oxaluria and 
chronic hepatitis, for which purpose one to four ounces of the acid 
may be added to a gallon of water. Dose, from gtt. ij-v, properly 
diluted, and carefully increased. 

Acidum Nitro-Hydrochloricum Dilutum {Diluted Nitro-Hydro- 
chloric Acid — Diluted Nitro- Muriatic Acid) is made by mixing nitric 
acid (4 parts) with hydrochloric acid (15 parts), and, when efferves- 
cence ceases, adding distilled water (76 parts). Dose, TTUj-x. 

Acidum Phosphoricum {Phosphoric Acid) is made by boiling 
phosphorus in nitric acid and water, and driving off the nitrous 
compounds by heat. It contains 50 per cent, each of orthophos- 
phoric acid (H 3 P0 4 ) and distilled water, and is "a colorless liquid, 
without odor, of a strongly acid taste and reaction," and has a sp. 
gr. of 1.347. It is a powerful caustic, penetrating the tissues very 
deeply. In its effects it resembles the other acids. In small doses, 
well diluted, it stimulates digestion and increases the circulation ; 
when given for too long a time it disorders digestion by diminishing 
the secretion of the acid gastric juice. In large doses it depresses 
the circulation, acting as a corrosive poison. Cases of poisoning 
by phosphoric acid are to be treated on general principles, viz. : neu- 
tralize the acid by the alkalies, alkaline earths or soap; protect the 
denuded surface by eggs, milk or mucilaginous drinks ; and coun- 
teract the resulting depression by opium, nutrient and stimulating 
injections, etc. It is used internally in the form of 

Acidum Phosphoricum Dilutum {Diluted Phosphoric Acid) which 
is prepared by adding 20 parts of phosphoric acid to 80 parts of 
distilled water. It is a colorless, syrupy liquid, without smell, but 
having a sour taste, and contains 10 per cent, of orthophosphoric acid. 

It has been used as a tonic and alterative in scrofula and in 
rachitis, but in the latter disease the phosphates are justly preferred. 
It may be used in dyspepsia, especially in those forms attended 
with acid eructations, heartburn, and ulcerative stomatitis, due to 
fermentation of food or excessive secretion of acid by the stomach. 
In these cases it should be given before meals. It is often added 
to cough mixtures. As it contains no free phosphorus it should 
not be given to produce the medicinal effects of that drug. Dose, 
KTlx-xxx diluted. 

ACIDUM LACTICUM— LACTIC ACID. 

This acid (HC 3 H 5 3 ) is formed in the souring of milk by the 
fermentation of its sugar under the influence of casein, between 68° 



182 MATERIA MEDICA AND THERAPEUTICS. 

and 84 F., and is a " syrupy, colorless, or pale wine-yellow liquid, 
having a slight bland or no odor, a very sour taste, and a sp. gr. 
1.2 1 2." It is also made by the action of a peculiar ferment on a 
solution of sugar. The official acid contains 75 per cent, of absolute 
lactic acid. Lactic acid unites in all proportions with water, alcohol, 
and ether, but is insoluble in chloroform and carbon bisulphide. In 
its effects it resembles the mineral acids, aiding digestion in small 
doses, while in large doses it disorders the stomach, causing flatu- 
lence and epigastric pain. It is a normal ingredient of the gastric 
juice, and it seems probable that the acidity of this secretion de- 
pends partly upon its presence. At all events, as far as digestion is 
concerned, it answers equally well with HC1. 

Given in large doses and long continued, it has caused rheumatic 
pains. 

It has been used in certain forms of dyspepsia depending on a 
deficiency of acid in the gastric juice, as in atonic dyspepsia, apepsia, 
and irritative dyspepsia, when it is given after meals and frequently 
combined with pepsin; in acidity and heartburn it may be given 
before meals to decrease the secretion of acid. It has also been pre- 
scribed for the removal of phospliatic deposits in the urine when these 
depend on disordered digestion. As a solvent for the false mem- 
branes of croup or diphtheria it has been used as a gargle or by 
atomization. Dose, TTLx-xxx, well diluted. 

PHOSPHORUS. 

Preparation and Test. — Phosphorus (P), which is never found 
in a free state in nature, is obtained from the calcium phosphate of 
bone-ash, by removing the lime with sulphuric acid, and afterward 
deoxidizing the residuum by heating with charcoal. It is a trans- 
lucent, highly inflammable, nearly colorless solid, resembling wax, 
without taste, but having a peculiar garlicky smell ; sp. gr. 1.830. It 
is insoluble in water, and dissolves sparingly even in the oils, ether, 
and alcohol but is soluble in carbon bisulphide. It emits, when 
exposed to the air, white fumes, which are luminous in the dark. It 
should be kept under water to prevent combustion. The most deli- 
cate test for free phosphorus is that of Mitscherlich, which consists 
in distilling the suspected substance with weak sulphuric acid in a 
flask and conducting the vapor in a tube through a glass conden- 
ser, the tube terminating in a bottle containing water placed under 
the condenser. That portion of the tube passing through the con- 



TONICS. 183 

denser must be surrounded by cold water contained within the latter, 
which, if phosphorus be present in the distillate, will condense it, 
causing a peculiar luminosity to be visible when observed in the 
dark. The water in the bottle may also be tested for phosphorus. 

Physiological Effects. — Locally ; when applied to the skin, 
phosphorus produces inflammation, ulceration, and even gangrene. 
The fumes of phosphorus are irritating to the conjunctiva and re- 
spiratory mucous membranes, and may produce necrosis of the 
maxillae, if the person exposed has caries of the teeth. This form 
is mostly observed among the artisans of match-factories. Nervous 
system : in small doses, it is a tonic and stimulant to the nervous 
system, aiding in the repair of waste. Circulation : phosphorus is 
absorbed by the blood, according to Bamberger. Either in the 
stomach or after entering the blood, a portion must unite with 
oxygen or hydrogen, as the odor of a phosphuretted compound is 
generally perceptible in the exhaled air of a person taking it. It 
stimulates the circulation, increasing the frequency and fullness of 
the pulse, and producing dilatation of the cutaneous capillaries. 
Large doses depress and weaken the cardiac action. Temperature : 
this is slightly elevated. Secretion : it increases the urinary secre- 
tion and the relative proportion of urea excreted, and gives to the 
urine an odor of violets. It stimulates the skin and increases the 
perspiration. In poisoning from phosphorus, albuminuria and 
hematuria have been observed. Osseous system : it stimulates the 
formation of bone, especially of the compact tissue, and the propor- 
tion of inorganic to organic matter is increased (Wegner*). Elim- 
ination : phosphorus passes out of the system by the liver and 
other glands, by the pulmonary mucous membrane, and by the 
skin. 

Toxicology. — When taken in large doses, or for a consid- 
erable time, phosphorus acts as a gastro-intestinal irritant caus- 
ing vomiting, purging, abdominal pain, an alliaceous taste in the 
mouth, the vomited matters and sometimes the stools being 
phosphorescent. Toward the end the pupils dilate, the abdominal 
walls are sensitive to pressure, there is great thirst and anxiety, and 
death may be preceded by convulsions. Hartman,f asserts that 
the temperature is finally elevated, the feces are of normal color, and 



* Virchow's Archives, 55, p. 11. 

f " Zur acuten Phosphorvergiftung," Dorpat, 1866. 



184 MATERIA MEDICA AND THERAPEUTICS. 

the urine contains biliary pigment and acids. Jaundice is a fre- 
quent sequela ; according to Alter,* the pathological changes in- 
volved in its production are swelling of the mucous membrane of 
the biliary passages and hypersecretion of bile — both due to fatty 
infiltration of the biliary epithelium and followed by absorption of 
bile. Wolfs,f who has studied the post-mortem appearances in six- 
teen cases, states that the blood is rendered more fluid, coagulation 
prevented, and the corpuscles altered in form. Vetter,"}; however, 
found the latter in normal condition. Hemorrhages take place or 
form in the serous cavities, especially in the pericardium and 
pleurae, due, doubtless, to the changes in the blood and fatty degen- 
eration of the capillaries and arterioles. The liver often becomes 
atrophied, undergoes fatty degeneration of its cells, as do also 
the other tissues, notably the muscles. The heart is soft and pale, 
and the parenchyma and cortex of the kidneys are infiltrated with fat 
cells. In fact, the ingestion of phosphorus, either in toxic amount 
or continuously, tends to the production of a general steatosis. 
Death has been caused by gr. jss-iij ; also from swallowing an infu- 
sion of matches (Woodman and Tidy). § The period when fatal 
varies from a few hours to seven days. 

Antidotes. — In cases of poisoning, an emetic should be admin- 
istered at once, preferably copper sulphate repeatedly given in small 
doses, partly for its emetic action and partly as a chemical antidote, 
since Bamberger || has shown that it forms with this salt a phos- 
phide, thus checking the intensity of its effects. The oil of turpen- 
tine, an antidote introduced by Andant,Tf who exemplified its 
virtues in the case of a woman poisoned by matches, has been 
frequently and with success employed against phosphorus (Laboul- 
lene,** Lecorche,ff RommelaeretJ). Personne,§§ experimenting on 
dogs poisoned with phosphorus, observed that almost all recovered 
to whom turpentine had been given. He thought it formed with 



* " Inaug. Diss.," Breslau, 1867. 

f " Inaug. Diss.," Berlin, 1868. 

\ Vir chow's Archives, 53, p 168. 

$ "Forensic Med.," etc., 1882, p. 95. 

|| Wurzburger Medicinische Zeit., 1866, p. 47. 

^ Bull. Gen. de Iherap., 75, p. 269 ; 76, p. 273. 

** Gaz. des Hop., xlvi, p. 361 ; Guz. Beb., 1874. P- 5 2 4- 

ft Arch, de Phys., t. i, p. 571 ; t. ii, p. 488. 

%% Bull. Gtn de Therapy 82, p. 145. 

$$ Bull. Gen, de Therap., 76, p. 353. 



ASTRINGENTS. 185 

phosphorus an insoluble mass or inert combination (turpento-phos- 
phoric acid, a spermaceti-like substance). French acid oil of tur- 
pentine, according to Vetter, (Joe. eit.) must be administered, and it 
should be old, as the real antidote appears to be oxygen in the 
form of ozone contained in oxygenated oil of turpentine. Fats 
and oils are to be avoided, as they increase the solubility of phos- 
phorus. The after-treatment consists in the exhibition of a brisk 
cathartic, such as magnesia. 

Medicinal Uses. — In suitable doses, phosphorus is a valuable 
stimulant and tonic to those tissues in which it is normally found, 
and it has been employed with advantage in cases of neurasthenia 
and degeneration of nerve-tissue, especially in neuralgia ; though 
Anstie * says its utility is neither extensive nor reliable in the 
last disease. It is administered with benefit in rachitis, angina 
pectoris (attack), in lymphadenoma, and has proved useful in some 
cases of pernicious anemia. It is one of the best aphrodisiac 
remedies we possess in functional impotence, and has been given in 
certain cutaneous affections, as lupus and psoriasis. The dose of 
phosphorus is gr. ^-jj. The official preparations are : pilule? phos- 
phori (phosphorus pills), each pill contains gr. T ^ ; oleum phosphor- 
atum (phosphorated oil), a solution of phosphorus (i part) in ether 
(9 parts) and almond-oil (90 parts) ; dose, gtt. v-xx. 

Zinci Phosphidum (Zinc Phosphide), (Zn 3 P 2 ), prepared by subject- 
ing fragments of zinc and phosphorus together to ebullition in a re- 
tort, through which a current of dry carbonic acid gas has been 
previously passed, has been employed in cases where the adminis- 
tration of phosphorus is indicated. It occurs as a gray, crystallized 
body, unaltered by moist air, and easily decomposed in the stomach, 
with the evolution of phosphuretted hydrogen. It has been found 
efficacious as a nerve-tonic in hypochondriasis ; also in eczema, 
psoriasis, and other cutaneous affections. Dose, about gr. -h~\. 

ORDER V.— ASTRINGENTS. 

These are medicines which produce contraction and corruga- 
tion of the tissues by a local action. Their constitutional effects 
are somewhat analogous to those of tonics ; and, like them, they in- 
crease the tone and vigor of the body, and exercise a control over 
various disorders of the nervous system. But they are chiefly em- 



*" Neuralgia," etc., 1871, p. 180. 



186 MATERIA MEDICA AND THERAPEUTICS. 

ployed to cure relaxation of the fibres and tissues, to subdue 
inflammation of superficial parts, and to arrest hemorrhage and 
excessive discharges from mucous membranes or other secreting 
surfaces. In checking morbid discharges from the bowels, astrin- 
gents diminish the secretions from the intestinal canal, and restrain 
their peristaltic movements, accomplishing this by a local action. 
They are divided into Vegetable and Mineral astringents. Most 
of the former owe their astringency to the presence of a principle 
termed tannic acid, and differ from tonics in the absence of bitter- 
ness. The mineral preparations usually classed among the astrin- 
gents are those of lead, copper, zinc, silver, bismuth and alum, and 
are distinguished from the mineral tonics by their more decided 
astringency and a sedative action on the vascular system. 

VEGETABLE ASTRINGENTS. 
ACIDUM TANNICUM— TANNIC ACID. 

Preparations and Tests. — This acid, which is the active 
principle of the vegetable astringents, is usually extracted from 
powdered nutgall by the action of washed ether. The nutgall, 
made into a soft paste with ether, is enveloped in a canvas cloth, 
and is pressed between tin-plates; the resulting cake is again 
mixed with washed ether and expressed ; and the expressed 
liquids are mixed, evaporated and dried ; the water seems to be 
the solvent which extracts the tannic acid. It is a light, feathery, 
non-crystalline powder, of a yellowish-white color and a strongly 
astringent taste, is very soluble in water, and soluble, though less 
so, in alcohol and ether. Tests. — It produces a white flocculent 
precipitate with solution of gelatin, a bluish-black precipitate with 
ferric salts (ink), and white precipitates with solutions of the vegeta- 
ble alkaloids; and these substances are to be, therefore, considered 
incompatible with all the vegetable astringents. There is a variety 
of tannic acid (inimo-tannic acid) obtained from kino, catechu, and 
some other substances, which strikes a greenish-black precipitate 
with the salts of iron, and is not convertible into gallic acid. Tannic 
acid (C 14 H 10 O 9 ) is a glucoside, yielding, besides glucose, gallic acid. 
Its hydrogen atoms are theoretically replaceable by bases, but the 
salts are not well defined. The most recent investigators consider 
tannic to be the anhydride of digallic acid. 

Incompatibles. — With the salts of iron (ferric and ferrous), 



ASTRINGENTS. 187 

lead, silver, antimony, the glucosides, and the alkalies, a precipitate 
is formed ; also with gelatin and the alkaloids. 

Effects and Uses. — Tannic acid applied locally to mucous 
membranes is a powerful astringent, and is applicable to all the 
cases in which astringents are useful. It precipitates peptones from 
watery solutions, but this does not take place in the presence of 
hydrochloric acid (Lewin). It checks the secretions of the mouth 
and stomach by constringing the calibre of the vessels, and it re- 
strains intestinal peristalsis. When applied in weak strength to the 
blood-vessels dilatation ensues, while a strong solution will contract 
them. Injected into the veins in large amount it coagulates albu- 
men, causing fatal thrombosis. Introduced in the same way, grad- 
ually, in moderate quantities, it exist as tannate of albumen, being 
held in solution by the alkaline carbonates (Lewin). According to 
Stockman's* investigations tannic acid in the stomach unites with 
alkalies, and in the intestine is converted into gallic acid; but it can- 
not be obtained as such, or at best a mere trace, from the blood. 
Probably the alkaline tannates in the stomach are absorbed at once, 
and on the amount of this absorption depends the quantity in the 
urine; for that in the intestine remains there a long while, being 
scarcely absorbed at all, is converted into gallic acid, and goes off 
by the bowel. Tannin is excreted in the urine of the rabbit as 
alkali-tannate, while in man it may be given a long time before it 
can be detected there with ferric chloride. The remote effects of 
tannin as ah astringent would seem to be valueless ; for when its 
affinities are satisfied in the blood, either with an alkali or albumen, 
it does not affect the calibre of the vessels nor precipitate albumen. 
It is used internally in the treatment of hemorrhage, colliquative 
sweats and in diarrhoea and dysentery where it is believed to act by 
forming a protective coating along the intestinal walls, and it is fre- 
quently prescribed in the form of tincture of catechu or kino. It is 
also used as an enema in diarrhoea, dysentery ', prolapsus ani and fis- 
sure of the anus, and, as a topical application, in hemorrhages, dis- 
charges from mucous membranes, as gonorrhoea and conjunctivitis, 
(gr. ij-v to aq. f§j), and ulcers, as a nasal wash in chronic nasal 
catarrh (gr. ij-v to aq. f§), to check the bleeding of epistaxis, retained 
in place with a cotton -wad, as an ointment in fissure of the nipple, 
and as an astringent gargle in cough and pharyngitis. It is doubtful 



k Brit, Med. Jour n., Dec. 4th, 1886, p. 1077. 



188 MATERIA MEDIC A AND THERAPEbTICS. 

if it possess the power to lessen the urinary albumen in Bright s 
disease. Dose, gr. j-iv, in pill, occasionally repeated. Troches of 
tannic acid are made by rubbing together tannic acid, powdered 
sugar and tragacanth, and forming a mass with orange-flower 
water; each troche contains of tannic acid gr. j. Ointment of tannic 
acid (iinguentum acidi tannici) is made by rubbing up io parts of 
tannic acid with 90 parts of benzoinated lard. 

ACIDUM GALLICUM-GALLIC ACID. 

Preparation and Test. — This principle is found in many 
of the vegetable astringents, but less uniformly than tannic acid, 
and is probably the result of changes which the latter has 
undergone. It is prepared by exposing a mixture of nutgall 
and animal charcoal in water to the air, in a warm place, for a 
month, when the tannic acid is gradually converted into gallic 
acid by the absorption of a molecule of water, since the most 
recent experimenters (H. Schiff, Sac and Lowe) have shown that 
tannic acid is the anhydride of digallic acid ; it is purified by being 
boiled in water and filtered through animal charcoal. It is also pre- 
pared by boiling powdered nutgall in dilute sulphuric acid (Liebig). 
If the conversion into gallic acid be completed there will be no 
turbidity on the addition of solution of isinglass. Test. — Gallic 
acid (HC 7 H 5 5 .H 2 0) is distinguished from tannic acid by not coagu- 
lating albumen or gelatin; and it unites with organic and inorganic 
bases to form gallates. For internal use, gallic acid is preferable to 
tannic, since it does not coagulate albumen. It occurs in small 
silky, nearly colorless crystals, having a slightly acid and astringent 
taste, and is soluble in boiling water, and slightly so in cold water. 

Incompatibles. — The mineral and organic bases. 

Effects and Uses. — Gallic acid is an astringent, of doubtful 
value, which has been extensively employed in hemorrhagic dis- 
orders, as uterine hemorrhage ', hemoptysis, hematuria, bloody diarrhoea, 
etc. But according to Stockman (loc. cit.) it has no other action 
than that of a weak organic acid, and only diminishes the alkalinity 
of the blood. Sodium gallate is without effect on the calibre of the 
vessels. Both tannic and gallic acids have been employed to dimin- 
ish the quantity of albumen in chronic Bright 's disease, but the proof 
of their utility in this condition is by no means conclusive. Gallic 
acid has but feeble local astringent powers, and is probably con- 
verted into tannic acid in the blood. Given by the stomach, it is 



ASTRINGENTS. 189 

more efficacious than the latter acid. It may be given in doses of 
gr. ij-v, in pill, every two or three hours. The ointment contains 10 
per cent, of gallic acid with benzoinated lard. 

GALLA— NUTGALL. 

Nutgall is an excrescence found upon Quercus lusitanica, var. 
infectoria, the Gall Oak (Nat. Ord. Cupuliferae), a small tree or 
shrub of Asia Minor. The gall-nuts are produced by the puncture 
of the buds by a fly ( Cynips quercus folii or Diplolepis gallcz tinctorice) 
to form a nidus for its eggs. This occasions an irritation and flow 
of juices to the part, resulting in the formation of a tumor around 
the larvae, which, on attaining maturity, perforate the gall and escape. 
Galls are produced chiefly in Syria and Asia Minor, and are im- 
ported from the Levant. They are brought also from Calcutta, 
being collected to some extent in India. Galls are spherical, about 
the size of a hickory-nut, with small tubercles on their surface. 
The best are bluish or black externally and grayish within, without 

Fig. 16. 




QUERCUS INFECTORIA (NUTGALL). 

odor, and of a very astringent, bitter taste. They yield their prop- 
erties to both water and alcohol, but best to the former, and contain 
tannic acid, 50 to 60 per cent, and gallic acid, 3 per cent.; mucilage 
sugar, etc. White galls are collected after they have been perfor- 
ated by the insect, and are inferior in astringency, containing only 
30 per cent, of tannic acid. 

Inxompatibl.es. — See tannic acid. 

Effects and Uses. — Galls are powerfully astringent, but are 
not much used internally. In the form of infusion or decoction 
they are employed as enemata in chronic diarrhoea and dysentery, and 
also as gargles. Dose of the powder, gr. x-xx. The tincture (20 
per cent., in glycerin and diluted alcohol) may be given in the dose 



190 MATERIA MEDICA AND THERAPEUTICS. 

of f5j-iij, but it is used chiefly as a chemical test. The ointment 
(10 parts to benzoinated lard 90 parts) is a favorite application in 
hemorrhoids t and may be advantageously combined with opium 
(5ss to ointment Sj). 

CATECHU. 

Catechu, formerly called Terra japonica, is an extract of the 
wood of Acacia Catechu, a small prickly tree of India [Nat. Ord. 
Leguminosae). Twelve or fifteen varieties of the drug are described 
by pharmacologists ; but it is usually met with in the shops in masses 
of various shapes and sizes, of a rusty-brown color externally and vary- 
ing internally from a reddish or yellowish-brown to a dark-brown 
color. The best is of a dark color, and is easily broken into small angu- 
lar fragments, with a smooth, glossy surface, bearing some resem- 
blance to kino. It is without smell, and has an astringent bitter taste. 
It contains about 50 per cent, of catechu- tannic acid, which strikes a 
greenish black precipitate with ferric salts, and about 30 per cent, of 
an acid principle, called catechin, to both of which it owes its pecu- 
liar properties ; also, in small amount, quercitrin and catechu-red. 

Incompatibles. — See tannic acid. 

Effects and Uses. — This is one of the most powerful and 
valuable of the vegetable astringents, possessing also mild tonic 
properties. It is much employed in combination with other reme- 
dies in chronic diarrhoea, dysentery, and hemorrhages, and is best 
administered half an hour before meals. It is a good deal used in 
relaxed conditions of the- mouth and throat, to relieve the hoarseness 
of public speakers, also in aphthous ulcerations of the mouth and 
spongy affections of the gums. Topically, it is employed as a styptic, 
and in solution as an injection in gonorrhoea and gleet. Dose of the 
powder, gr. x to 5ss in bolus or emulsion. 

Of the compound tincture (12 parts with cinnamon 8 parts in 
diluted alcohol to make 100 parts), the dose is f5j-iij., useful with 
morphia in acute diarrhoea. The troches each contain of catechu, 
gr. j, with sugar, tragacanth, and orange-flower water. 

KINO. 

The term Kino is applied to the products of several trees. Five 
varieties are known. 1. East India kino, which is the most common, 
is the inspissated juice of Pterocarpus Marsupium (Nat. Ord. Legu- 
minosse), a lofty tree of Malabar. 2. African kino, the original 
variety introduced into Europe, but not now met with ; obtained 
from Pterocarpus erinaceus. 3. Botany Bay kino, the concrete juice 



ASTRINGENTS. 191 

of Eucalyptus resinifera [Nat. Ord. Myrtaceae), a large tree of Aus- 
tralia. 4. Bengal or Palas kino, from the Butea frondosa {Nat. Ord. 
Leguminosae). 5. Jamaica and Caraccas kino, the extract of the wood 
and bark of Coccoloba uvifera, or Seaside Grape {Nat. Ord. Poly- 
gonaceae), a small tree of South America and the West Indies. 

East India kino* is met with in small, angular, shining fragments, 
of a dark-brown or reddish-brown color, brittle, without smell, but 
with a very astringent taste. It contains kino-tannic acid, kino-red, 
pyrocatechin (a trace), and kindin. 

South American kino comes in large masses, externally very 
dark, and internally of a deep reddish-brown color. 

Jamaica kino resembles the last, but is contained in large 
gourds. 

Incompatibles. — See tannic acid. 

Effects and Uses. — Kino is a powerful astringent, and is much 
used in chronic diarrhoea and dysentery, leucorrhoea, gonorrhoea, and 
hemorrhages. Externally , it is employed as a styptic, and as a stimu- 
lant to indolent ulcers. Dose of the powder, gr. x-5ss ; of the tinc- 
ture (10 parts, glycerin 15 parts, alcohol and water to make 100 parts 
of tincture), f5j-ij may be given, and it is frequently added to chalk- 
mixture in diarrhoea. 

KRAMERIA. 

Krameria or Rhatany is the root of Krameria triandra and of 
K. tomentosa (Nat. Ord. Polygaleae), shrubs of Peru, Bolivia, and 
New Granada. It occurs in woody cylindrical pieces, of the thick- 
ness of a goose-quill to twice that size — many radicles being often 
united to a common head. They have a dark, reddish-brown bark, 
and a tough central ligneous portion, of a lighter red color. They 
are without smell, but have a very astringent, slightly bitter and 
sweetish taste, which is much stronger in the cortical than the lig- 
neous portion ; and hence the smallest pieces should be preferred, 
as they contain the most bark. Rhatany yields a large proportion 
of kramero-tannic and rhatanic-red. It imparts its properties to both 
cold and boiling water, but more fully to alcohol. 

Incompatibles. — See tannic acid. 

Effects and Uses. — Rhatany is powerfully astringent, with 
some tonic properties. It is much used in the treatment of chronic 
diarrhoea, dysentery and hemorrhages, and as an enema. Trousseau 

* For an analysis of Kino, see Am. Jour, of Phar., April, 1889. 



192 MATERIA MEDICA AND THERAPEUTICS. 

strongly recommends its use in fissure of the anus, and in tenesmus 
due to chronic dysentery or hemorrhoids ; it is also used in hemor- 
rhoids and leucorrhcea. The powdered extract is an ingredient in 
many tooth-powders, and the tincture is used also as an astringent 
mouth-wash. Dose of the powder, gr. xx-xxx ; watery extract, 
dose, gr. x-xv ■; fluid extract, dose, f5ss-j ; tincture (20 per cent.), dose, 
f5i-ij ; and syrup, dose, fSj-iv. The troches each contain gr. ij of 
Krameria with sugar, tragacanth and orange-flower water. 

HEMATOXYLIN. 

Logwood, or Campeachy wood, is the heart-wood of Hema- 
toxylon campechianum (Nat. Ord. Leguminosae), a medium-sized 
tree of Campeachy and other maritime parts of tropical America, 
and now naturalized in the West Indies. The portion used in medi- 
cine, and also as a dye, is the heart-wood, from which the bark and 
white sap-wood are removed previous to exportation. It is imported 
in billets of different sizes, of a dark color externally and a deep red 
internally ; in the shops it is kept in chips or raspings. It has a 
sweetish, astringent taste, and a feeble, not unpleasant, smell. It 
contains tannic acid, a coloring principle called hematein, hematoxylin 
(C 16 H 14 6 ), resin, etc. 

Incompatibles. — See tannic acid. 

Effects and Uses. — It is a mild astringent, useful in chronic 
diarrhoea and dysentery, and particularly well adapted to the weak- 
ened condition of the bowels which follows cholera infantum. Mothers 
should be told that the stools of infants taking hematoxylon will 
stain their napkins red. It is also employed in the diarrhoea 
of phthisis. It is given in decoction in the dose of f oj to adults, 
and f 5j to children ; or watery extract, in the dose of gr. x-xxx in 
solution. 

QUERCUS ALBA— WHITE OAK. 

The barks of several species of American oaks possess astrin- 
gent properties, and are probably to be found in the shops, but the 
only official variety is Quercus alba, White Oak (Nat. Ord. Cupu- 
liferae). The inner bark is the portion used, but the leaves and 
acorns also are astringent. White-oak bark is distinguished by its 
whitish color. When prepared for use, it is deprived of its epider- 
mis, and is of a light-brown color and fibrous texture, with an as- 
tringent and bitterish taste. Water and alcohol extract its virtues, 
which depend mainly on the presence of querci-tannic acid (C 28 H 24 12 ), 
tannin, oak-red, etc. 



ASTRINGENTS. 193 

Effects and Uses. — A decoction of white-oak bark is a good 
remedy in chronic diarrhoea and hemorrhoids, and is employed as an 
enema in hemorrhoids and prolapsus, and fissure of the anus, as a 
gargle in relaxation of the uvula, and as an injection in leucorrhcea 
without inflammation and where the discharge is profuse, in check- 
ing which the mineral astringents have failed. It, however, stains 
the linen. 

It is also used on a cotton-tampon in uterine involution, and 
rcctocele when these conditions are due to relaxation of the parts, 
or when operative interference is not justifiable. Of decoction of 
white-oak fgij may be taken frequently. 

GERANIUM. 

One of the most powerful of the indigenous astringents is Gera- 
nium maculatum, Crowfoot, or Cranesbill {Nat. Ord. Geraniaceae), a 
perennial herbaceous plant, growing in moist woody situations, with 
an erect stem one to two feet high, pale-green, mottled leaves, and 
large purple flowers, w r hich appear in April and May. The part 
used is the rhizome, which should be collected in the autumn. This, 
when dried, occurs in wrinkled, rough pieces, from a quarter to a 
half an inch in thickness, furnished with slender fibres, of a dark- 
brown color externally, and a pale flesh-color within. It has an as- 
tringent but not bitter taste, and no smell, and contains tannic and 
gallic acids with mucilage. 

Effects and Uses. — This is an excellent simple astringent, 
agreeing very well with the stomach, and might be advantageously 
substituted for the more expensive foreign drugs. It may be used 
internally to fulfill the indications of kino, rhatany, etc., in bowel 
complaints and hemorrhages, and topically as an enema, gargle, in- 
jection, etc. It is* also a styptic. Dose, in powder, gr. x to xx ; of 
the decoction, f5j-ij may be given. A decoction in milk is given 
to children. The fluid extract may be taken in doses of f5ss-j. 

hamamelis. 

Hamamelis Virginica, or Witchhazel {Nat. Ord. Hamamelaceae), 
is a shrub, from six to ten feet high, growing in the damp woods of 
the United States and Canada. The leaves are the official part, and 
should be collected in the autumn. They are bitter and astringent. 
The bark may also be used. Hamamelis contains tannic acid (8.10 
per cent.), a bitter-principle not yet accurately determined, etc. 
*3 



194 



MATERIA MEDIC A AND THERAPEUTICS. 



Effects and Uses. — Hamamelis is an astringent, and, accord- 
ing to Phillips, possesses probably a hemostatic and shrinking power 
over veins, especially those of the skin and mucous membranes. It 
has been used with success in passive hemorrhages, in hematemesis, 



FIG. 17. 




GERANIUM MACULATUM. RHIZOME. 



hemoptysis* and hematuria. It is beneficial in hemorrhoids, f check- 
ing the bleeding and reducing the size of the enlarged veins. For 
this purpose it may be given internally and used as an injection, be- 
ginning with 5j to water f§ij, and gradually increasing the strength. 



* Bull. Gen. de Therap., cvi, p. 193. Dujardin-Beaumet2 
f Ibid. 



Sur Hamamelis Virginica. 



ASTRINGENTS. 195 

The injection should be taken morning and evening, and retained, 
and it must be continued for some time. It is also recommended 
locally in inflammations and congestions. The fluid extract is the 
only official preparation ; dose, f5ss-j. 

The following vegetable astringents deserve notice, though less 
frequently employed than the foregoing : — 

Rosa Gallica (Red Rose) ; Rosa Centifolia (Pale Rose) (Nat. 
Ord. Rosacese). The petals of these two species of rose are offi- 
cial, but those of almost every other species of cultivated rose may 
be employed for the same purpose as Rosa centifolia, which is not 
astringent. The red rose is a mild astringent. The fluid extract 
is used as a flavoring ingredient in gargles and mouth-washes, and to 
disguise the taste of other medicines, as Glauber or Epsom salts. 
The confection is used as a basis for pills. Mel Roses (Honey of Rose), 
made with diluted alcohol and clarified honey, is used as an addi- 
tion to gargles ; the syrup is added to mixtures. The pale rose is 
slightly laxative. Aqua Rosce (Rose- Water), distilled from the pale 
rose, is much employed in collyria, etc. Unguentum Aquce Rosce 
(Ointment of Rose-Water) is made by melting together oil of almond 
50 parts, spermaceti 10 parts, white wax 10 parts, and then gradu- 
ally adding rose-water 30 parts ; this is a very soothing application, 
much used under the name of cold cream. Serviceable when ap- 
plied to blistered surfaces, chaps and lichen. 

Rhus Glabra (Sumach). This is an indigenous shrub growing 
to the height of from four to twelve feet, having a somewhat bent 
stem " divided into straggling branches, covered with smooth light 
gray or somewhat reddish bark, and imparipinnate leaves " with 
from twenty-one to thirty-one lance-oblong, pointed, and serrate 
leaflets. The fruit is in " clusters of small crimson berries which 
are subglobular, about one-eighth of an inch in diameter, drupa- 
ceous, densely haired, containing a roundish-oblong, smooth puta- 
men." 

They contain acid calcium and potassium malates, tannin, color- 
ing matter, etc. (Maisch), and are excellent astringents, especially 
valuable as a gargle in aphthce and other forms of sore mouth and 
in pharyngitis, for which purpose the fluid extract may be diluted 
with two or more parts of water. 

Rubus (Blackberry). The bark of the root of Rubus villosus, 
Rubus trivialis and Rubus Canadensis (Nat. Ord. Rosaceae), the 
former (the common American Blackberry) an erect, prickly shrub, 



196 MATERIA MEDICA AND THERAPEUTICS. 

and the two latter (Dewberries) creeping briers, are very efficient 
mild astringents, which have been used with excellent effect in 
bowel complaints, especially those of children, particularly diar- 
rhoea. The astringency resides principally in the cortical portion, 
and hence the smallest roots should be preferred. According to 
Krauss' * analysis the root-bark contains an amorphous glucoside, 
villosin, and about 10 per cent, of tannin. The fluid extract may be 
given in doses of f 5j-ij ; the syrup is made by adding 20 parts of 
the fluid extract to syrup 80 parts ; dose, fSss. 

Castanea {Chestnut). The leaves of the Castanea vesca 
(Nat. Ord. Cupuliferse), a stately tree indigenous to both hemi- 
spheres, are official. They should be gathered in the autumn while 
still green. They contain tannin, etc., and are used occasionally in 
whooping-cough. Dose of the fluid extract, f.5ss-ij. 

A large number of vegetable substances, both indigenous and 
foreign, have been used as astringents in addition to those enume- 
rated, the astringent principle being the most common medicinal 
property with which plants are endowed. The foregoing list com- 
prises the more important. 

MINERAL ASTRINGENTS. 
PLUMBI PR.EPARATA— PREPARATIONS OF LEAD. 

Metallic lead is considered inert. The sulphide and sulphate 
are probably also inactive ; but with these exceptions, all the com- 
pounds of lead possess more or less activity. The tests for lead 
are sulphuretted hydrogen and a solution of potassium iodide ; the 
former strikes a black and the latter a yellow precipitate with solu- 
ble lead-salts. The editorf has ascertained that sulphuretted hydro- 
gen will detect one part of a soluble lead-salt in one million parts of 
water. 

Incompatibles. — The mineral acids and their soluble salts, the 
alkalies and alkaline earths, vegetable astringents, opium, potassium 
iodide, and the sulphides are incompatible with the plumbic salts. 

Aids. — The lead-salts are aided in their depressive action on the 
circulation by prolonged cold, aconite, veratrum viride, and ergot ; 
in their astringent effects by the salts of zinc, copper, bismuth, and 



* Am. Journ. Pharmacy, Dec, 1889. 

\Am.I. M. S.. October, 1878, C. Biddle, M.D., U. S. Navy. 



ASTRINGENTS. 197 

silver, and in their depressing influence upon nutrition by mercury, 
antimony, copper and the metals which increase tissue-waste. 

Physiological Effects. — When applied locally in solutions 
not too concentrated, they coagulate albumen, contract the blood- 
vessels, and consequently blanch the tissues, but are not absorbed 
by the skin.* When more highly concentrated solutions are ap- 
plied, they act as irritants, producing inflammation. When admin- 
istered in therapeutical doses, they act as astringents in the alimen- 
tary canal, checking secretion and causing constipation. Rutherford 
states that lead acetate is the only drug which decreases the secre- 
tion of the bile without causing purgation, and he attributes this 
effect to a direct action on the liver. The lead preparations probably 
enter the blood from the stomach as albuminates, and pass directly 
to the liver,f by which they are chiefly eliminated, though a trace 
may be found in the urine. From the intestine they are only 
slowly absorbed and in small quantity. After absorption they irri- 
tate the cardiac inhibitory centre, at the same time acting on the 
terminal intro-cardiac branches of the vagus, thus diminishing the 
frequency of the cardiac beat (which under large doses becomes 
intermittent), lessening the duration of the systolic bruit, and pro- 
longing the diastolic bruit ; in this way a diminution in the volume 
and frequency of the pulse is produced. % They also decrease the 
activity of the secreting functions, and frequently arrest sanguineous 
discharges, both natural and artificial. 

Toxicology and Antidotes. — In excessive doses, several of 
the saturnine compounds are irritant and corrosive poisons, giving 
rise to gastro-enteric inflammation, and sometimes to paralysis, 
coma, and collapse. The toxic dose of lead acetate is 5j-ij, but 
it is rarely fatal, owing to the vomiting it produces. The proper 
antidote is sulphuric acid or some alkaline or earthy sulphate, in 
solution in a large quantity of diluent. 

Chronic Lead-Poisoning. — When the system becomes im- 
pregnated with lead, either from the too long-continued use of 
its preparations medicinally, from drinking water drawn through 
lead-pipes, or from exposure to its influence in lead-factories, 
etc., a peculiar kind of chronic poisoning is produced, which 



* Journal de V Anatomie et de la Physiol., 1873, P- 2 35- 

f Ibid. 

% Gaz. Hebdom., August, 1883, CurcL 



198 MATERIA MEDICA AND THERAPEUTICS. 

shows itself by a variety of symptoms. The most usual form 
of lead-poisoning is colic, sometimes termed colica Pictonum, 
and painter's colic, which is characterized by sharp abdominal 
pains, with hardness and depression of the abdominal parietes, 
obstinate constipation, nausea and vomiting. Dr. Ernest Harneck, 
from experiments on the lower animals, concludes that colica Picto- 
num is due to intense excitation of the intestinal ganglia by the 
lead, producing arrest of peristalsis from spasm of the muscular coat, 
and recommends belladonna or atropine as affording speedy relief. 
According to Bardenhewer, pilocarpine relieves the colic with 
equal rapidity. Next in frequency is lead-arthralgy, in which there 
are severe pains in the limbs, attended by cramps, hardness and 
tension of the painful parts. Lead-paralysis is another, though less 
common, variety of the disease, and is characterized by a loss of 
voluntary motion, owing to the want of contractility of the muscu- 
lar fibres of the affected parts. It most frequently affects the upper 
extremities, and the extensor rather than the flexor muscles. Oc- 
casionally, functional disease of the brain is also observed as one of 
the consequences of lead-poisoning. The absorption of lead into 
the system is recognized by a saturnine coloration of the gums, of 
the mucous membrane of the mouth, and of the teeth. In a series 
of experiments made by the editor,* the fact was established that the 
emanations from fresh lead paint do not contain lead. It seems 
proven, therefore, that in order to induce saturnine poisoning, actual 
contact is necessary with paint or lead in some form. 

The Antidotal Treatment of Chronic Lead-Poisoning con- 
sists in the internal administration of solutions of sulphuric acid and 
of soluble alkaline and earthy sulphates, and in the use of baths of 
potassium sulphide, dissolved in warm water, by which the salts of 
lead, deposited on the skin, are converted into the insoluble sul- 
phide. Potassium iodide is employed as an eliminative remedy. 
For lead-colic, a combination of cathartics and opiates has been 
employed; but the best remedy is alum, in doses of 5j-ij, every 
three or four hours, dissolved in some demulcent liquid. In the 
treatment of lead-palsy, strychnine and electricity may be used, but 
it is a very intractable form of the disease. The use of sulphuric 
aciH lemonade is resorted to by workmen in lead-factories, as a 
preventive of lead-poisoning. Milk has been found also to answer 

*Am.J. M. S., October, 1878, C. Biddle. Prize thesis. 



ASTRINGENTS. 1 99 

the same purpose. By passing a strong solution of potassium or 
sodium sulphide, heated to the temperature of 21 2° F., through 
leaden pipes, the interior surface will become coated with an insolu- 
ble lead sulphide, and the water distributed through them will be 
free from contamination. 

Medicinal Uses. — The preparations of lead are employed as 
astringents, sedatives and desiccants. For internal use the acetate is 
almost exclusively employed. It is a most valuable remedy in 
hemorrhages, obstinate diarrhoea and dysentery, and in the treatment 
of internal aneurism from its combined sedative and astringent 
influence, and it is also very serviceable in fluxes from the mucous 
membranes, particularly of the bowels. Topically, lead-washes are 
employed to relieve superficial inflammation, to arrest morbid dis- 
charges, and as desiccants. They are objectionable, however, as 
eye-washes, from their often forming precipitates of lead upon the 
cornea. 

Plumbi Acetas (Lead Acetate). This salt (Pb2C 2 H 3 2 .3H 2 0), 
known also as saccharum saturni or sugar of lead, is made by 
immersing lead in distilled vinegar, or litharge in pyroligneous or 
crude acetic acid. It occurs in colorless, needle-shaped crystals, 
which effloresce on exposure to the air. They have an acetous 
odor and a sweetish, astringent taste, and are soluble in both water 
and alcohol. 

Effects and Uses. — The effects of this salt are those of the 
saturnine preparations which have been already described. Its 
medicinal influence is sedative and astringent. In hemorrhages it 
is employed internally, usually in combination with opium. This 
combination is also much resorted to in the treatment of diarrhoea, 
dysentery and cholera, cholera morbus and may be prescribed with 
advantage to arrest the night-sweats of phthisis. In the cure of 
internal aneurism the acetate is prescribed alone, but with unsatis- 
factory results. In acute diarrhoea, if there be abdominal pain and 
frequent serous stools, the acetate should be combined with opium: 
1^ Plumbi acetatis, gr. xij ; opii pulveris gr. vj. M.S. — Ft. pil. no. 
vi ; one after each stool. This is equally efficacious in dysentery, 
but the proportion of opium should be increased. In yellow-fever 
it is employed to check the hemorrhagic condition of the gastric 
mucous membrane. It is a dangerous remedy in chronic diseases, 
from the liability to lead-poisoning, when its administration is long 
continued. As a topical remedy, lead acetate, in aqueous solution, 



200 MATERIA MEDIC A AND THERAPEUTICS. 

is extensively employed to relieve inflammation and diminish mor- 
bid discharges ; also in suppository with opium to check rectal 
hemorrhage. Dose, gr. j-ij-viij, two or three times a day. When 
applied to mucous membranes, as in gonorrhoea, the strength of the 
solution may be gr. ss-j or ij to water f§j ; for phlegmonous in- 
flammation, as boils, abscess, and prickly heat, 5ij to water Oj. 
When it is desirable to combine opium with lead as an external 
application, the following formula will be found a cheap and 
efficacious substitute for " lead-water and laudanum:" 1^ Opii 
pulveris, 5j ; plumbi acetatis, gj. S. — Put the powder in a pint of 
boiling water and stir ; when cool apply externally on a cloth of 
several thicknesses : a serviceable anodyne lotion for sprains, synovitis, 
parojiychia, phlegmons and orchitis. 

Liquor Plumbi Subacetatis {Solution of Lead Subacetate). This 
preparation, frequently termed Goulard's Extract, is an aqueous so- 
lution of lead diacetate (Pb 3 2 2C 2 H 3 2 ), and is made by boiling lead 
acetate and litharge in distilled water. It is a colorless liquid which 
is decomposed on exposure to the air, with the formation of insolu- 
ble lead carbonate, and occasions a dense white precipitate with so- 
lution of gum. In other respects it resembles a solution of lead 
acetate. 

Medicinal Uses. — -It is chiefly employed, diluted, to promote 
the resolution of external inflammation and to arrest the discharges 
from suppurating, ulcerated and mucous surfaces. It is advantage- 
ously employed in the moist varieties of acute eczema, and also in 
cases accompanied with much heat. In orchitis, solution of the 
subacetate applied frequently to the scrotum, on lint, together with 
absolute rest and support of the parts, constitutes an efficient plan 
of treatment. The official dilution is liquor plumbi subacetatis 
dilutus, commonly known as lead-water, and consists of solution 3 
parts to distilled water 97 parts. Ceratum plumbi subacetatis, or 
Goidard's Cerate, is made by mixing Goulard's extract (20 parts) 
and camphor-cerate (80 parts) ; it is an admirable dressing to excori- 
ated and blistered surfaces, burns and scalds. Linimentum plumbi 
subacetatis {liniment of lead subacetate} is made by mixing cotton- 
seed oil with Goulard's extract. 

Plumbi Iodidum {Lead Lodide) (Pbl 2 ) is made by the double 
reaction of solutions of lead nitrate and potassium iodide. It is a 
bright-yellow, heavy, inodorous powder, volatilizable by heat, spar- 
ingly soluble in cold water, but more soluble in boiling water. It 



ASTRINGENTS. 201 

may be given internally in the dose of gr. iij-iv, or more, in pill ; 
but it is principally employed externally in the form of ointment 
(10 parts to benzoinated lard 90 parts). 

Plumbi Nitras {Lead Nitrate) (Pb2N0 3 ), made by dissolving 
litharge in diluted nitric acid, occurs in white, nearly opaque, octa- 
hedral crystals, permanent in the air, of a sweet, astringent taste, 
and soluble in water and alcohol. It may be given internally, as a 
sedative astringent, in doses of gr. %-], twice or thrice daily, in pill 
or solution. Dr. Fordyce Barker recommends it as an application 
to fissured nipples (gr. x in glycerin f§j), and the breast must be 
carefully washed before nursing. Ledoyen's Disinfecting Fluid is a 
solution of lead nitrate 5j in water f5j. 

Plumbi Oxidum (Lead Oxide) (PbO), or Litharge, is prepared 
by blowing air through melted lead, and is obtained also in the 
process for extracting silver from argentiferous galenas. It occurs 
in minute yellowish or orange-colored scales, insoluble in water? 
and is never employed internally. It is sometimes sprinkled over 
ulcers, but its chief use is in the preparation emplastrum plumbi, or 
lead-plaster (called also diachylon), a lead-soap, which is made by 
boiling litharge with olive-oil in water, and is, chemically, a mixture 
of lead oleate and margarate. It serves as a basis for most of the 
other plasters. Unguentum diachylon* (diachylon ointment) consists 
of lead-plaster 60 parts melted with olive-oil 39 parts, and incor- 
porated when partly cool with oil of lavender 1 part. This is an 
excellent soothing application in chronic eczema with scales and infil- 
tration, after the parts have been cleansed with sapo viridis, and 
should be laid on with muslin ; it may be equally well applied to 
pemphigus. Emplastrum saponis (soap-plaster), made by rubbing up 
soap with lead-plaster, is an excellent discutient ; useful in bed-sores. 

Plumbi Carbonas (Lead Carbonate), or White Lead, is manu- 
factured in this country by exposing lead to the fumes of vinegar 
or acetic acid, carbonic acid being derived from the fermentation of 
tan, in which the pots containing lead are packed ; lead oxy-acetate as 
formed, is converted into the carbonate. It is a white powder, with- 

* A better preparation, because more soothing and grateful to the inflamed skin, is 
that known as HebrcCs Ointment, which consists of the best olive-oil f^xv; finely-pow- 
dered litharge ^iij-^vi; and water Oj. The water and oil are to be boiled over a 
steam-bath, the litharge sifted in and stirred, and the boiling kept up till all the particles 
have disappeared. During this process, 3 or 4 ounces more of water should be added ; 
then stir till cool. 



202 MATERIA MEDICA AND THERAPEUTICS, 

out smell or taste, and insoluble in water, and, as it occurs in com- 
merce, is a compound of lead carbonate and hydrate (2PbC0 3 .Pb2 
HO). It is never administered internally, but it is employed as a 
dusting powder — though there is danger of its absorption. Un- 
guentum plumbi carbonatis (10 parts to benzoinated lard 90 parts) is 
a good application to burns, etc. White paint is used for the same 
purpose, but when applied to a large surface it may produce lead- 
poisoning. 

CUPRI PR^EPARATA— PREPARATIONS OF COPPER. 

Metallic copper is inert. The tests for the soluble salts of cop- 
per are : potassium ferrocyanide (which throws down a mahogany- 
colored precipitate), ammonia (which strikes an azure-blue color), 
sulphuretted hydrogen, or ammonium sulphide (which throw down 
a deep brownish-black precipitate), and metallic iron (on which 
metallic copper is deposited from a cupreous solution). 

Incompatible^. — The sulphides, the alkalies and their carbon- 
ates, the mineral salts (except the sulphates), the iodides and vege- 
table astringents. 

Aids. — See lead. 

Physiological Effects. — The salts of copper act locally as 
caustics, irritants, and astringents, by their coagulating action on 
albumen ; applied to the sound skin they produce but little effect. 
They also constringe the tissues and lessen the blood-supply to a 
part. In the blood they probably exist as albuminates. Some ob- 
servers have noted a gain in flesh, in animals and man, after a course 
of copper. Taken too long they give rise to symptoms similar to 
plumbic poisoning, viz., constipation, paralysis, etc. When ex- 
hibited in small doses, they seem to exert a corroborant influence 
over the cerebro-spinal system, and are occasionally employed to 
fulfill the indications to which tonics are applicable, as in neuralgia. 
In larger doses they produce gastric irritation and act as emetics. 
Lauder Brunton * has ascertained experimentally that copper sul- 
phate injected into the blood likewise causes retching and vomiting, 
probably brought about, he thinks, by irritation of the stomach and 
intestines, which is reflected to the vomiting centre of the medulla. 
Copper is eliminated by the liver, intestines, and kidneys. 

Toxicology and Antidotes. — In excessive doses, they pro- 
duce gastro-intestinal inflammation and disorder of the nervous 

* St. Bartholomew'' s Hosp. Reports, XII, p. 145. 



ASTRINGENTS. , 203 

system ; death, in fatal cases, is usually preceded by convulsions, 
paralysis, and delirium. In cases of poisoning from the cupreous 
compounds, the best antidote is albumen, as white of eggs, milk, 
wheaten flour. The potassium ferrocyanide is also very efficacious, 
forming with the cupreous compounds an insoluble copper ferro- 
cyanide. 

Medicinal Uses. — The salts of copper are employed therapeu- 
tically, both as external and internal remedies ; externally as stim- 
ulants \ astringents, styptics , and caustics; internally as emetics, 
astringents, and tonics. 

Cupri Sulphas [Copper Sulphate). This salt, known as blue 
stone and blue vitriol, is obtained by roasting the native sulphide, or 
by combining cupric oxide (CuO) and sulphuric acid. It is cupric 
sulphate (CuS0 4 .$H 2 0). It occurs in fine prismatic blue crystals, 
which, by exposure to the air, effloresce slightly and become covered 
with a greenish-white powder. It has a styptic, metallic taste, is 
entirely soluble in water, but insoluble in alcohol. As an astringent, 
it may be given in doses of gr. y^ to j, or more, in pill, repeated so 
as not to occasion vomiting, and will be found extremely valuable 
in the treatment of chronic diarrhoea, dysentery, and enteritis. It is 
also used as an antidote to phosphorus. As an emetic, the dose 
is gr. iij to v, or even more in narcosis. Externally, it is used as a 
mild escharotic to trachoma, condylomata, and idcers, and in solution 
to arrest hemorrhages and muco-purulent discharges, as gonorrhoea. 
In gonorrhoea gr. y 2 -} to water fSj is a suitable strength to begin 
with. 

Cupri Acetas [Copper Acetate) (Cu 2 2C 2 H 3 2 .H 2 0) occurs in deep, 
bluish-green or green rhombic prisms. The dose is gr. y& to gr. J^. 
It resembles the sulphate in its effects and uses. 

ZINCI PRiEPARATA— PREPARATIONS OF ZINC. 

Zinc in its metallic state is inert. The test for soluble zinc 
salts is ammonium sulphide, which throws down a white sulphide 
(the only white sulphide met with). 

Incompatibles. — The sulphides, the alkalies, fixed and volatile, 
silver nitrate, the vegetable astringents, and the acids. Between 
zinc sulphate and lead acetate a double decomposition takes place, 
not, however, interfering with its local effect. 

Aids. — Remedies aiding copper and lead (q. v.) 

Physiological Effects. — Its compounds are very analogous 
in their effects on the system to those of copper, but are less ener- 



204 MATERIA MEDICA AND THERAPEUTICS. 

getic. Topically some of the zinc salts (nitrate, chloride) act as 
powerful caustics, by reason of their affinity for water and power of 
coagulating albumen. The soluble zinc salts (sulphate, chloride) 
are readily absorbed, and probably exist in the blood as albuminates, 
while the insoluble salts (oxide, carbonate) are slowly taken up by 
the blood. Zinc is eliminated from the system by the bile, intes- 
tines, and urine. In cases of poisoning (rare), albumen, demulcents, 
and opiates are to be administered. 

Medicinal Uses. — The zinc preparations are employed topically 
as caustics, astringents, and de sice ants ; and internally, as tonics, 
astringents, and, in large doses, as emetics, 

Zinci Sulphas {Zinc Sulphate) (White Vitriol) (ZnS0 4 7H 2 0) 
is prepared by dissolving zinc in dilute sulphuric acid. It occurs 
in small colorless, transparent, prismatic crystals, resembling those 
of magnesium sulphate. They have a metallic, astringent taste, are 
soluble in water and insoluble in alcohol, and produce their astrin- 
gent effect by condensing the tissue and contracting the blood-ves- 
sels. Internally , it is chiefly used in chorea and by Hammond in 
large doses (gr. ij-xx, t. d.). Dose, as a tonic and astringent, gr. j 
to v ; as an emetic (acting by gastric irritation), it is the promptest 
and safest that can be given in cases of narcotic poisoning, in the 
dose of gr. x-xx, well diluted in water. It is a suitable astringent for 
the treatment of obstinate chi'onic diarrhoea and in enteritis with pro- 
fuse stools. Externally , it is much used as a caustic, and in solution 
as a collyrium in conjunctivitis , as an astringent nasal wash in chronic 
nasal catarrh, and in gonorrhoea, gleet and urethritis, in the 
strength of gr. j-ij-iij to water f§j ; in otorrhcea, gr. v. to water fgj. 

Zinci Oxidum {Zinc Oxide) is made by roasting zinc in the air. 
This is an impure form, known as Commercial Zinc Oxide (Zinci 
Oxidum Venale), sometimes called tutty, A purer form is obtained 
by exposing precipitated zinc carbonate to heat, which expels the 
carbonic acid and water. It is a yellowish- white powder (ZnO), 
insoluble in water, but soluble in diluted sulphuric and hydro- 
chloric acids. It is occasionally used in the treatment of epilepsy ; 
dose, gr. ij, in pill, gradually increased. It is now mostly employed 
externally as a dusting powder, and often combined with starch and 
applied in the early stage of acute eczema, and to pemphigus, or in 
the form of ointment (20 parts to benzoinated lard 80 parts). This 
ointment has a wide range of usefulness, it being serviceable in bed- 
sores to keep the parts supple, in chilblain as a soothing application 



ASTRINGENTS. 205 

after puncture of the blebs, as a simple dressing to herpes and 
herpes zoster, roseola, sycosis , intertrigo, impetigo and erythema. 

Zinci Acetas [Zinc Acetate) is made by heating commercial 
zinc oxide in a solution of acetic acid and distilled water, and oc- 
curs in white micaceous crystals (Zn2C 2 H 3 2 .2H 2 0), very soluble 
in water, and efflorescent in dry air. It is used chiefly as a topical 
astringent in ophthalmia i gonorrhoea, gleet and leucorrhcea, (5j to 
tepid water Oj) in the proportion of gr. ij to vj, or more, to water, 
f§j. As an injection in the third stage of gonorrhoea, it was the 
remedy preferred by Bumstead,* and its strength should be regu- 
lated just short of irritation of the urethra. 

Zinci Carbonas Prascipitatus {Precipitated Zinc Carbonate) is 
obtained by the double reaction of solutions of zinc sulphate and 
sodium carbonate. It is a soft, white powder, a mixture of car- 
bonate and hydrate (ZnC0 3 ) 2 .3Zn(HO) 2 , similar in its action to the 
oxide, but is chiefly used as a dusting powder, and to make a mild 
astringent and desiccant cerate (5j to ointment §v). 

Liquor Zinci Chloridi {Solution of Zinc Chloride) may be used 
to disinfect water-closets and sinks. The evaporation of this solu- 
tion yields 

Zinci Chloridum {Zinc Chloride) (ZnCl 2 ), a whitish-gray, semi- 
transparent, deliquescent mass, having the softness of wax, and 
soluble in water, alcohol and ether. Its local action is that of a 
powerful caustic, and it is one of the best escharotics that can be 
exhibited, to produce healthy granulations in malignant or indolent 
ideers, especially in lupus. It may be used as a lotion in the 
strength of gr. ij to fSj of water, or dissolved in a little alcohol, or 
in the form of paste, made with one part of the salt to two or four 
of flour. A solution of zinc chloride is employed as an antiseptic, 
and is also injected into the blood-vessels of anatomical subjects to 
preserve them for dissection. Burnett's Disinfecting Fluid is a 
solution of about gr. cc in water fSj. 

Zinci Iodidum {Zinc Iodide) (Znl 2 ) is made by digesting an 
excess of zinc with iodine diffused in water. It occurs in the form 
of a white deliquescent mass, or of fine needles, of a metallic, styp- 
tic taste, very soluble in water. Externally, it is a most valuable 
local stimulant and escharotic, equal if not superior in effect to the 
chloride, and is much used. 

* '■' Venereal Diseases," 1879, P- 59- Bumstead and Taylor. 



206 MATERIA MEDICA AND THERAPEUTICS. 

Zinci Valerianas {Zinc Valerianate) (Zn2C 5 H 9 2 .H 2 0) is pre- 
pared by the double reaction of sodium valerianate and zinc sul- 
phate. It occurs in white, pearly scales, having a faint odor of 
valerianic acid, and a metallic, styptic taste. It dissolves in ioo 
parts of water and 40 of alcohol. Used in epilepsy and nervous 
affections, in the dose of gr. i-ij, repeated several times a day, in 
pill or capsule. 

ARGENTI PR^EPARATA— PREPARATIONS OF SILVER. 

Incompatibles. — The salts of silver form white curdy precipi- 
tates with the chlorides and hydrochloric acid; with solutions of 
potash and soda they yield a brown argentic oxide ; with the ox- 
ides and bromides yellow deposits are obtained, and with many of 
the organic acids they afford insoluble compounds, Silver nitrate 
is reduced by organic matter to an oxide, becoming blackened ; the 
extracts of opium and hyoscyamus are said not to produce this 
effect. 

Aids. — The copper, lead and zinc preparations enhance the 
effects of the silver-salts. 

In the metallic state, silver is wholly inert. The only prepa- 
ration which is extensively employed is 

Argenti Nitras {Silver Nitrate). This salt (AgN0 3 ) is obtained 
by dissolving silver in diluted nitric acid. It is anhydrous, and 
occurs in transparent, colorless, shining, heavy, rhombic plates, 
which have a strongly metallic and bitter taste, and are wholly 
soluble in distilled water. 

Physiological Effects. — The topical action of silver nitrate to 
mucous membranes is that of a caustic, by reason of its coagulative 
action on albumen. This action does not extend deeply, since a 
superficial protecting pellicle is formed. When moistened and ap- 
plied to the skin, a white stain is formed, which soon becomes 
black on exposure to light, by reduction of the silver to the metal- 
lic state. Internally. — Nervous system : in animals, hypodermic 
injections of silver hyposulphite and albuminate have caused para- 
plegia. In small doses,|tetanic excitement, and in toxic, convulsions, 
were produced. On man the argentic salts have caused vertigo, 
loss of memory and nervous depression. The effects of silver on 
the nervous system are centric and not peripheral. Circulation : 
the intravenous injection of the silver-salts impairs the coagulabil- 
ity of the blood, which is found to be dark and pitchy in color. 



ASTRINGENTS. 207 

Other symptoms noted by this method were probably due to the 
production of embolism and thrombosis. The silver-salts do not 
exert a toxic influence on the heart. They have a metallic, styptic 
taste. Small doses (oxide, gr. j£, nitrate, gr. ^) may be taken 
with considerable impunity by the stomach. But, in excessive 
quantity (of nitrate, gr. iij-v), it is apt to occasion gastro-enteric irrita- 
tion, with disturbance of the nervous system ; and in these cases 
the antidote is common salt (sodium chloride), or any inert chloride, 
which produces, when in contact with the nitrate, sodium nitrate 
and silver chloride. Silver nitrate has been thought always to un- 
dergo conversion into a chloride in the stomach ; but more proba- 
bly it unites with albuminous matters, which render it soluble. In 
medicinal doses, it has a corroborant action on the nervous system ; 
and, after prolonged use, since its elimination takes place slowly, 
produces a peculiar indelible blueness or slate color of the true skin 
(argyrid), due to a deposition of the metal in the tissues. This, it 
has been asserted, is preceded by a peculiar blue line on the gums, 
resembling that produced by lead-poisoning. Prolonged use of 
the silver-salts (in animals) causes a marked loss of weight. Elim- 
ination takes place by means of the bile, kidneys (chiefly) and 
intestines.* 

Medicinal Uses. — Internally, silver nitrate has been employed 
in the treatment of epilepsy, but it is much inferior to the bromides 
in the treatment of this intractable affection ; and its effect in dis- 
coloring the skin is an objection to its protracted use. It is used 
also successfully in locomotor ataxia, being especially extolled by 
Rosenthall, Charcot, and others, in the dose of gr. j£, t. d. ; but in 
this disease the galvanic current, in addition to medicines, renders 
important aid. It has been prescribed, too, in that intractable con- 
dition called spinal sclerosis. In gastric ulcer and chronic gastritis 
it is also efficacious in small doses in pill-form, after the stomach is 
afforded rest by liquid diet, preferably with milk. As an astringent 
in chronic dysentery and diarrhoea, combined with opium its exhibi- 
tion may prove serviceable. But it is as an external agent that it is 
most resorted to. It is one of the best applications that can be 
made to inflamed mucous membranes, and, either in the solid form 
or in solution, it is employed in every variety of inflammation of 
this tissue. It is also extensively used to produce healthy granu- 

* Journal de V Anatomie et de Physiologie, 1873, P- 2 %9- 



208 MATERIA MEDICA AND THERAPEUTICS. 

lations in trachoma, wounds and ulcers; to arrest the progress 
of erysipelatous inflammation, and the pustules of small pox ; in 
porrigo and other skin diseases. The strong injections of silver 
nitrate, formerly used to abort acute gonorrhoea being ex- 
tremely painful, are now rarely resorted to. In this disease, either 
of the male or female urethra, the best results are obtained by using 
solutions of the strength of gr. %-]-i], to water f gj, care being 
taken to avoid staining the clothing with it. As a collyrium it is 
contraindicated when ulcer of the cornea exists, for fear of forming 
an opacity. If a strong collyrium be used (gr. v-x to water fgj), 
in conjunctivitis, either simple or granular, or in ophthalmia, gonor- 
rheal or non-specific, for the relief of which it is an excellent ap- 
plication, the effect on the conjunctiva should be counteracted by 
flushing it out with a weak solution of salt and water, or even with 
cold water alone. Topical applications of solution of silver nitrate 
gr. v-x to water fSj, applied with a sponge, are highly serviceable 
in acute pharyngitis, and tonsillitis, and to the post nasal space in 
acute and chronic nasal catarrh. When thus employed, if there be 
much phlegm about the part, it should be cleansed with Dobell's 
solution prior to the application of the silver. Silver nitrate 
stains can be removed by moistening the spot with tincture of 
iodine and then washing it with solution of sodium hypophosphite. 
It may be used to destroy the virus of poisoned wounds, but its 
action as a caustic is too superficial to be of much service for this 
purpose. 

Administration. — The dose of silver nitrate internally is gr. \, 
gradually increased to gr. y 2 or j. t. d., in pill, made with Fuller's 
earth and petroleum mass, and given soon after a little light food 
has been taken. For external use, solutions are made of various 
strengths, from gr. ij— 5ss or more in fgj of distilled water, and the 
bottle should be protected by blue paper from the reducing action 
of light. An ointment is also employed. 

Argenti Nitras Fusus (Moulded Silver Nitrate — Lunar Caustic). 
For external use, in the solid form, silver nitrate is melted and 
poured into small moulds. 

Argenti Nitras Dilutus {Diluted Silver Nitrate) consists of 50 
per cent, each of silver nitrate and potassium nitrate. It is used 
externally. 

Argenti Oxidum (Silver Oxide) (Ag 2 0) is obtained by adding 
solution of potassa to a solution of silver nitrate. It is a tasteless, 



ASTRINGENTS. 209 

olive-brown powder, very slightly soluble in water. Its action and 
applications are analogous to those of the nitrate, and it is consid- 
ered to be free from liability to discolor the skin. Dose, gr. ss-j, 
twice or thrice daily in pill. Used in pyrosis. 

Argenti Iodidum [Silver Iodide) (Agl) may be used in gastric 
and uterine affections instead of the nitrate. It is also said to have 
some alterant effects. Dose, gr. j-ij. 

BISMUTHI PR^EPARATA— PREPARATIONS OF BISMUTH. 

Incompatbiles. — The bismuth-salts being insoluble can not be 
prescribed with other agents in solution. 

Aids. — Morphia and tannin enhance the astringency of the 
bismuth-salts ; calomel and pepsin its sedative influence upon the 
gastro-intestinal tract. With these agents it may be prescribed 
either in capsule, powder, or lozenge. 

Metallic bismuth is inert. The salts are very insoluble, but to 
a slight extent are absorbed and eliminated* slowly, as bismuth has 
been found in the urine,f blood, etc., after their administration. 
The unabsorbed residue, passing down the alimentary canal, is con- 
verted into a sulphide and colors the stools black. The test for a 
bismuth salt is to concentrate it in acid solution and then pour this 
into water when a white precipitate falls, insoluble in tartaric acid. 

Bismuth Subnitras (Bismuth Subnitrate). This salt is prepared 
by forming bismuth nitrate by dissolving bismuth in diluted nitric 
acid, suitable means at the same time being taken to get rid of arsen- 
ical contamination, as metallic bismuth usually contains arsenic. 
Bismuth subnitrate, known as pearl white and magistery of bismuth 
(BiON0 3 .H 2 0), is a white, inodorous, tasteless powder, insoluble in 
water. 

Effects and Uses. — Its medical properties are tonic, sedative and 
astringent. It is used chiefly to allay nausea and check vomiting in 
chronic affections of the stomach, as ulcer, gastric cancer, gastric ca- 
tarrh, gastro-intestinal irritability and gastrodynia, in which gr.xv.-xx 
should be given t. d., in order to obtain its effects. It is also much 
employed as an astringent in acute and chronic diarrhoea. As bismuth 
exerts its astringent influence on the intestinal tract by a local protec- 
tive action, in the diarrhoea of adults it may be given, advantageously, 
in large doses (5ss-j), to be taken one hour before each meal. It is 

* Journal de P Aiiutomie it de li Physiologie, 1873, p. 243. 
"f Transactions Am Neurological Association. 1883, p. 24. 

14 



210 MATERIA MEDICA AND THERAPEUTICS. 

particularly useful in any form of diarrhoea where the stools con- 
tain mucus ; and acute diarrhoeas occurring during the summer 
season are also frequently benefited by it. The following combi- 
nation is of great service : ^ Morphinse sulphatis, gr. y 2 -) ; bismuthi 
subnitratis, 5j-ij ; sodii bicarbonatis, 5j ; sacchari lactis (seu pulveris 
cinnamomi), 5ij. M. et div. in chart, xii. Sig. — One powder after 
each alvine dejection. It is often advantageously given suspended 
in an emulsion of castor oil with laudanum, in these and similar 
complaints. It is one of the numerous remedies for pyrosis. Dose, 
gr. v-xx, or even 5ss, in powder or pill. Externally \ it is a good 
remedy in skin diseases as acute eczema in the form of ointment. 
^ Bismuthi subnitratis, 5ij ; zinci oxidi, 5^ ; glycerini, f5jss ; acidi 
carbolici liquidi, TTLxy ; vaselini albi, §vi, M. S. Ft. ungt. Mixes 
into an enamel-like cream. The following forms a good antiseptic 
application in the treatment of ulcers and certain skin affections, as 
impetigo : Jfy Iodoformi, 3j ; acidi borici, 5ij ; bismuthi subnitratis, 
5iv; petrolati, §ij. M. Sig. — Ft. ungt. It is also well combined 
with camphor as a dusting powder, to intertrigo, or with boracic 
acid in the treatment of purulent otorrhoea of the external auditory 
meatus. 

Bismuthi Subcarbonas (Bismuth Subcarbonate) — (Bi 2 2 C0 3 .H 2 0) 
is recommended as a substitute for the subnitrate. It is thought to 
be more readily tolerated by the stomach, and is more soluble in 
the gastric juice, but it is less astringent. Dose, gr. v-xx, or even 
5ss, in powder or pill. 

Bismuthi et Ammonii Citras (Bismuth and Ammonium Citrate) , 
which occurs in glossy, translucent, colorless scales, of a slightly 
acid, metallic, but not disagreeable taste, very soluble in water, is a 
good preparation as an astringent. It is much more astringent 
than the insoluble preparations, but is more irritant; dose, gr. ij. 

The valerianate (not official) has been used in neuralgia; dose, 
gr. %-], several times a day, in pill. 

CER1I OXALAS— CERIUM OXALATE. 

This salt (Ce 2 (C 2 4 ) 3 .9H 2 0) is usually made by adding a solu- 
tion of ammonium oxalate to any soluble salt of cerium, and is 
obtained also from the mineral cerite. It occurs as a snow-white, 
granular powder, inodorous and tasteless, insoluble in water, alco- 
hol, and ether, but dissolved by sulphuric acid. It resembles the 
salts of bismuth in its effects, and has been deservedly extolled in 



ASTRINGENTS. 211 

obstinate forms of vomiting, especially the vomiting of pregnancy. 
In chorea and other neuroses it is also highly recommended. Its 
physiological action has not been investigated. Dose, gr. j. t. d., or 
oftener, in pill or suspended in water. The cerium nitrate has been 
also employed, and is more soluble. Dose, somewhat less. 

ALUM EN— ALUM. 

Incompatibles. — The alkalies and their carbonates, the salts of 
the acidulous radicals, lime-solution, magnesia and its carbonate, 
potassium tartrate and lead acetate are incompatible with alum. 

Aids. — It is aided in its action by the vegetable and mineral 
astringents. 

Alum is a double salt, an aluminium and potassium sul- 
phate (K 2 A1 2 4S0 4 .24H 2 0). It is manufactured from aluminous 
schist, and sometimes by the direct combination of its constituents. 
It crystallizes in regular octahedrons ; but is commonly found in 
the shops in large, colorless transparent crystalline masses, without 
any regular form. It has an astringent and sweetish, acid taste ; 
by exposure to the air it slowly effloresces ; it is soluble in cold 
water, and more so in boiling water ; and when heated it undergoes 
the watery fusion, swells up, and gives out its water of crystalliza- 
tion, and is converted into a white, spongy mass called dried alum. 

Besides the potassium alum, there are varieties in which the 
potassium is replaced by some other base, as ammonium or sodium; 
the official alum was formerly the aluminium and ammonium sul- 
phate, but this has been superseded by potassium alum. 

Physiological Effects. — The immediate topical effect of alum 
is that of a powerful astringent, in virtue of a chemical action on 
the tissues. When it is applied to a part in large quantities, the 
astriction is soon followed by irritation ; and thus, taken internally 
in excessive doses, it gives rise to vomiting, griping, purging, and 
even inflammation of the gastro-enteric mucous membrane. After 
its absorption it acts as an astringent on the system generally, pro- 
ducing constriction of the tissues and fibres, contraction of the capil- 
laries, and a diminution of secretion. It is eliminated chiefly with 
the feces. After large doses, Orfila detected it in the urine of dogs. 
Death has resulted in man from dried alum Sjss. 

Medicinal Uses. — Alum is employed internally in hemorrhages, 
chronic diarrhoea, and it is sometimes combined with cubeb in the 
treatment of gleet and gonorrhoea, as in the following prescription : 



212 MATERIA MEDIC A AND THERAPEUTICS. 

1^ Pulveris aluminis, 5j ; pulveris cubebse, 5iv ; pulveris cinnamomi, 
5ss. M. et Sig. — Tablespoonful in half a glass of water 3 times a 
day ; an efficient mixture when it does not disorder the stomach. 
Alum is also used as an injection in leucorrhoea. It has, too, been 
given as an emetic in croicp. Its use in lead-colic has been alluded 
to. As a topical remedy it is valuable as an astringent-antiphlogistic 
in ophthalmia, diphtheria, and tonsillitis ; to produce contraction of 
the tissues, in relaxation of the uvula , prolapsus ani, uterine involution , 
rectocele, and it is used as a vaginal injection where the tissues become 
lax from wearing a pessary; as a styptic in hemorrhages ; and to 
arrest excessive secretion from the mucous surfaces. In hemoptysis 
and clironic bronchitis, a strong solution of alum may be. applied to 
the larynx by atomization. Topically, it is employed in the form 
of solution, and is useful in trachoma, conjunctivitis, and as an 
injection in gonorrhoea, attended with profuse discharge, gr. ij-vj 
to water f§ij ; in leucorrhoea, 5j to tepid water Oj. In the treat- 
ment of pharyngeal cough and pharyngitis the throat may be 
swabbed with an alum-solution. An alum-lotion is a good appli- 
cation to fissure of the nipples, and as a gargle in mercurialismus. 

Administration. — Dose, gr. x-xxx, in powder or solution, 
or made into pills with some tonic extract, and combined with an 
aromatic, as nutmeg, to prevent nausea. It may be agreeably given 
in the form of whey, prepared by boiling 5ij with milk Oj, and 
straining, of which the dose is f§ij. Dried alum (alumen exsic- 
catum) is employed internally in the dose of gr. v-x, and externally 
as a mild escharotic. 

Aluminii Sulphas {Aluminium Sulphate} (A1 2 3S0 4 . i8H 2 0) is 
employed externally as an astringent and antiseptic application to 
ulcers, and as an injection in gonorrhoea. The aqueous solution is 
used to preserve bodies for dissection. 

ALUM-WATERS. 

Churchill Alum ( Virginia). One U. S. gallon contains magne- 
sium sulphate, gr. 86 ; calcium sulphate, gr. 88 ; ferric sulphate, gr. 
51 ; aluminium sulphate, gr. 72, and silica, gr. 10. 

Bath Alum-Springs ( Virginia). Analyst A. A. Hayes : Con- 
tains in one U. S. gallon alumina, gr. 12 ; ferrous sulphate, gr. 22; 
with small quantities of the earthy and potassium sulphates. 

Rockbridge Alum-Springs (Rockbridge County, Virginia). There 
are 3 springs, the one containing the most alumina yielding gr. 3 to 
the pint. They are astringent and styptic. 



STIMULANTS. 213 

Cresson Springs, of Pennsylvania, contain aluminium sulphate, 
gr. 21 ; and ferrous oxide, gr. 16 to the U. S. gallon. 

The alum-waters are applicable to the treatment of affections in 
which the aluminium preparations are prescribed, as chronic diar- 
rhcea and dysentery. They are particularly useful where iron is 
indicated. 

ORDER VI.— STIMULANTS. 

Stimulants are medicines which produce a rapid and temporary 
exaltation of the vital functions. Their influence is most conspicuous 
in conditions of morbid depression, when a marked tolerance of 
their action is established, and large amounts are borne. In health* 
when the powers of the system are at the normal standard, stimu- 
lants soon induce depression. Topically , they irritate and inflame 
the parts to which they are applied, and hence are classed with 
irritants. 

Stimulants are employed principally in disorders known as 
asthenic, and in all conditions of the system attended with exhaus- 
tion. From their action in arousing the energies of the nervous sys- 
tem, they exercise a control over many nervous disorders, particu- 
larly those of a spasmodic nature. They are also frequently given 
with a view to their action on some one or other of the secretions. 
As stimulants to the gastro-intestinal canal, they are administered 
to promote digestion (when they are called stomachics) and to dispel 
flatulence (when they are known as carminatives). Topically, they 
are employed as rubefacients and vesicants. 

The more powerful and rapid stimulants are called diffusible. 
In overdoses, they act as violent narcotics and sedatives. The dif- 
fusible stimuli usually employed are vinous and spirituous liquors 
and the preparations of ammonia. Vegetable stimulants which 
contain a volatile oil are termed aromatics, and are usually given as 
stomachics, and carminatives. The volatile oils are also employed 
as local irritants. 

DIFFUSIBLE STIMULANTS. 
ALCOHOL. 

Alcohol is a product which results from a process termed the 
vinous fermentation, in substances containing grape-sugar. At a 
temperature of 8o° F., the presence of a fermenting body converts 
a solution of grape-sugar into alcohol and carbonic acid. Starchy 
substances, being convertible into grape-sugar, also yield alcohol. 



214 MATERIA MEDICA AND THERAPEUTICS. 

Alcohol is obtained from vinous or fermented liquors by repeated 
distillation. It is, chemically, an ethyl hydrate (C 2 H 5 HO). Official 
alcohol should be of the sp. gr. 0.820. It is a colorless, inflamma- 
ble liquid, wholly vaporizable by heat, and unites in all proportions 
with water and ether. Contamination of fusel oil or amylic alcohol 
may be detected by agitation with concentrated sulphuric acid, 
when, if the alcohol become colored, the presence of the impurity 
is indicated in proportion to the depth of the color; or solution of 
silver nitrate, with exposure to a bright light, will convert fusel oil 
into a black powder. 

Aids. — As a cerebral stimulant, ether, cocaine, cannabis In- 
dica; as a cardiac excitant nux vomica, ammonia and atropia. 

Contraindications. — Chronic hepatic, heart and renal disease, 
atheroma of the vessels, tendency to obesity, and alcoholic dypso- 
mania. 

Physiological Effects. — Alcohol * is the intoxicating ingre- 
dient of all vinous and spirituous liquors.*)" Locally \ alcohol acts as 
an astringent by hardening the albumen and condensing the tissues. 
It evaporates rapidly, causing a feeling of coolness. When evapor- 
ation is prevented, it acts as an irritant (due to absorption and pa- 
ralysis of the cutaneous vessels), and may even produce inflamma- 
tion. When inhaled it may produce anaesthesia, stupor and death. 
Nervous system : when taken internally, in small doses, it stimulates 
the cerebral hemispheres, possibly by the hyperemia induced; in 
large doses it causes excitement with impaired coordination of 
ideas; and in excessive doses it produces coma. Small doses stim- 
ulate the spinal cord, while larger amounts weaken the centers 
governing automatic motion and coordination, and lessen the sen- 
sibility of the cutaneous nerves, especially that of the fifth pair of 
cranial nerves. Large doses paralyze the vaso-motor nerves, giving 
rise to dilatation of the arterioles, flushing of the surface, and sen- 
sations of heat. In inflammatory diseases, medicinal doses contract 
the arterioles by giving tone to the vaso-motor system, and prevent 
the migration of white corpuscles (Farquharson). In toxic doses, 
the nervous centers are involved in the following order: 1. The 



* Alcohol considered chemically, physiologically, medicinally and as a cause of disease. 
Essay awarded the Henry C. Lea Prize, Jefferson Medical College, March, 1878, by Henry 
Morris, M. D. 

t According to Dujardin-Beaumetz the toxic effects of the alcohols increase with the 
sum of their atomic weights, with the exception of the highest and lowest. 



STIMl I.AXTS. 215 

gray matter of the convolutions and the higher functions of animal 
life (shown by disordered intellection). 2. The basic ganglia (shown 
by disordered sensation and motion). 3. The cerebellum (shown 
by disordered equilibration. This may be in part due to impair- 
ment of the muscular sense). 4. The spinal centres (shown by 
anaesthesia of the lower limbs, extending to the upper limbs and 
body, difficulty in performing automatic acts, impaired coordination, 
etc.). 5. The medulla oblongata (shown by labored breathing, and 
finally death from apncea). Circulation: alcohol at first stimulates, 
but afterward depresses the cardiac motor ganglia. In small doses 
it increases the frequency of the cardiac beat, without affecting the 
force or rhythm, increasing the rapidity of the contraction and 
shortening the diastole (Parkes and Wollowicz), and also elevating 
the arterial tension. This is soon followed by slowing of the heart 
and lowered arterial tension, and if the dose has been excessive, by 
weak and irregular contraction. Large doses depress and paralyze 
the cardiac muscle. Respiration is at first quickened, but afterward 
slowed. In alcohol-narcosis the breathing is very slow, and death 
may result from apncea. Temperature: small doses slightly elevate 
the temperature. If large amounts have been taken, the tempera- 
ture is depressed, owing to the radiation of heat from the dilated 
cutaneous vessels, to lessened oxidation of tissue, and, in alcohol- 
narcosis, or in the case of animals, to muscular inactivity. The 
power of resisting cold is lessened by the habitual ingestion of 
alcohol. Secretion : the secretions are at first increased, then di- 
minished. Alcohol diminishes the quantity of urea, uric acid, so- 
dium chloride, phosphoric and sulphuric acids excreted in the urine, 
and augments the urinary flow. Sugar is sometimes found in the 
urine after the ingestion of alcohol. Small doses stimulate the 
liver, while larger amounts alter the quality of the bile, which may 
be profuse or scanty. The amount of carbonic acid exhaled from 
the lungs is diminished. Stomach: alcohol is rapidly absorbed 
from the stomach, so quickly indeed that upon a person unaccus- 
tomed to its use it produces stimulating effects almost at once ; small 
doses increase the flow of the gastric juice by the production of 
hyperemia about the tubules, and thus excite the appetite and favor 
digestion. Large doses check the gastric secretion, precipitate the 
pepsin, and cause anorexia and nausea. When taken habitually, it 
produces a slow interstitial inflammation of the mucous membrane 
with hyperplasia of the connective tissue-elements, which, contract- 



216 MATERIA MEDICA AND THERAPEUTICS. 

ing, compress the gastric glands. The secretion will then be much 
diminished, and the mucous membrane covered with a ropy, glairy- 
mucus. Blood: alcohol must be in a certain state of dilution before 
it can be absorbed. It is said to precipitate the albumen in the 
blood, but it must be in a condition too diluted to accomplish this, 
nor are the consequences of an occasional indulgence sufficiently 
serious to warrant this statement. It diminishes the power of the 
red corpuscles to carry oxygen, and when taken continually alters 
the composition of the blood by its effect on the liver and digestion. 
Fat in the blood of drunkards is increased from 8.65 parts to 11.7 
parts per 1 000 (Lecaun). Scharlau found 30 per cent, more carbon 
in the blood of drunkards than in that of healthy persons*. This is 
due to the avidity with which alcohol combines with oxygen, pre- 
venting the oxidation of the hydrocarbons. Muscular system: the 
muscular power is weakened and the muscular sense diminished. 
Elimination : alcohol is eliminated unchanged in small proportion 
to the quantity ingested, by the kidneys, lungs, and to a slight ex- 
tent by the skin, and probably by the liver, traces having been de- 
tected in the bile by Dr. Percy. A portion of the alcohol (about 
f§iij) disappears in the system, being probably oxidized, for Anstie * 
in a series of elaborate experiments on dogs, was able to recover 
only about one-fourth of the amount administered. The economy 
seems to be able to consume this quantity daily, storing it up as 
potential energy, anything above this being carried away under an- 
other form by the eliminating organs. Though foiij may disappear 
in the system, yet it is not to be considered as contributing at all to 
the normal support of the body. Experience gained in Arctic voy- 
ages proved that alcohol was totally unnecessary as an article of 
diet, and that tea as a restorative stimulant was a much better 
substitute. 

Toxicology and Antidotes. — The symptoms of acute and of 
chronic poisoning by alcohol are too well known to need descrip- 
tion. The treatment in cases of poisoning from alcohol is the 
same as that which is to be. pursued in cases of poisoning from 
opium, except the use of atropia and flagellation. Ammonia is a 
physiological antidote, and later the exhibition of strychnia does 
good. Mania-a-potn is found in acute poisoning from alcohol, and 
is due to the direct action of alcohol on a brain rather unaccus- 

* The Practitioner, Vol. Ill, p. 15. 



STIMULANTS. 217 

tomed to its effects. It differs from delirium tremens, which is a 
delirium of a trembling type found in chronic alcoholism. The 
habitual use of alcoholic narcotics in excess gives rise to a well- 
known train of mental and physical disorders ; viz., dyspepsia, 
visceral obstructions, cirrhosis of the liver, gout, organic disease of 
the heart, Bright's disease, delirium tremens, paralysis, and even 
confirmed insanity. 

Medicinal Uses. — Alcohol, in the form of vinous and spirit- 
uous liquors, is employed to rouse and support the system in 
asthenia, pyemia, septicemia, asphyxia, syncope, shock, typhoid and 
typhus fevers, asthenic and malignant diseases, exhausting hemor- 
rhages and suppurations, gangrene, to counteract the effects of 
the bites of venomous reptiles, in delirium tremens, and in poison- 
ing from digitalis, tobacco, and other narcotics; also as a stomachic 
in colic, flatulence, dyspepsia, nausea, etc. In typhoid and typhus 
fevers, alcohol probably acts as a physiological antidote to the 
blood-poison, and should be given in the very first stages of 
these fevers, regulating the size and frequency of the dose by 
the sounds of the heart and the character of the pulse. Rarely 
more than fSvj-viij are required daily. As a stimulant in diphtheria 
its administration is of the greatest service in counteracting the 
depressing effects of the poison, in cerebrospinal meningitis to 
arouse from collapse, to sustain the vital powers in capillary 
bronchitis, and in the treatment of acute lobar pneumonia, to prevent 
heart-insufficiency it is our most efficient remedy, the indications 
for its administration being the same as in typhoid fever. Indeed the 
early administration of the preparations containing alcohol furnishes 
our best means of counteracting the depressing action of disease 
in general. The true stimulant or supporting effects of alcohol 
probably depend upon its appropriation by the system through 
oxidation or other agency. In disease, large quantities are 
administered which cannot be recovered in the excretions. But in 
health, when the powers of the economy are at the normal 
standard, it probably circulates in the blood unchanged, and 
accumulates in the viscera or is eliminated by the secretions. In 
insomnia due to cerebral anemia, a little alcohol at bedtime will 
often produce refreshing sleep. Alcohol, when prescribed to build 
up the system, should be given after food, in order to hinder it 
from diffusing too rapidly into the blood. For this purpose it is 
administered in conditions of anorexia, in convalescence from acute 



218 MATERIA MEDICA AND THERAPEUTICS. 

maladies, in neurasthenia, phthisis and cerebral anemia. Small 
doses induce aphrodisiac effects and are therefore serviceable in 
functional impotence. The hypodermic injection of a syringeful of 
brandy or whiskey, repeated if necessary, is an efficient restora- 
tive in collapse and in asthenic conditions generally, especially 
where dissolution appears to be imminent. As a topical application, 
alcohol is used to produce cold by its evaporation ; as a styptic; to 
harden the cuticle over delicate parts, as in bed-sores ; and as a 
stimulant with ammonia water it makes a useful wash in premature 
alopecia. Mixed with white of eggs, it forms a good coating to 
bed-sores. 

Alcohol Dilutum [Diluted Alcohol), or Proof- Spirit, consists of 
equal parts of alcohol and distilled water, and has a sp. gr. 0.928. 
It is used exclusively for pharmaceutical purposes. 

Vinum {Wine). The fermented juice of the grape consists of 
water and alcohol in varying proportions with fixed and volatile 
acids, sugar, cenanthic acid and ether, tannic, malic and other acids, 
potassium bitartrate, etc. Wine loses most of its cream of tartar by 
age. It is employed medicinally in typhus and typhoid fevers, con- 
valescence, exhausting chronic diseases, extensive suppurations, gan- 
grene, asthenia, etc. In typh-fevers it constitutes our chief thera- 
peutic resource, and may be administered to the amount of one or 
two pints in the twenty-four hours, either pure or in the form of 
wine-whey . This is made by adding from a gill to half a pint of 
white wine to a pint of boiling milk, separating the curd from the 
whey, and flavoring with sugar and spices. 

The official wines are Vinum Album (White Wine), containing 
between 10 and 12 per cent, of absolute alcohol by weight; Vinum 
Album Fortius (Stronger White Wine), containing between 20 and 
25 per cent, of absolute alcohol; and Vinum Rubrum (Red Wine), 
containing between 10 and 12 per cent, of absolute alcohol. Red 
wines are more astringent than white, as they contain more tannic 
acid. They are suited to conditions of anemia. Port Wine contains 
tannic acid, and is used in chronic dysentery and diarrhoea, for its 
astringency. Madeira, which is the strongest of the white wines, is 
an excellent stimulant, but may be objectionable from its acidity. 
Champagne is a pleasant stimulant where gastric irritability is 
present, particularly iced champagne in yellow fever. Madeira and 
port contain about 23 per cent, of alcohol; sherry, 19 per cent.; 
champagne, 13 per cent. As articles of diet, the stronger wines, 



STIMULANTS. 219 

when used in excess, often produce gout, and diseases of the kid- 
neys and liver ; and except in advanced age and in feeble constitu- 
tions, or where the tuberculous diathesis exists, cannot but be con- 
sidered as objectionable. 

Spiritus Vini Gallici (Brand)') is obtained by the distillation of 
wine. It contains about 50 per cent, of alcohol, with water, volatile 
oil, tannic acid, coloring matter, etc. It is the best stimulus where a 
rapid and decided impression is called for, as in collapse and syncope ; 
and, from the tannic acid which it contains, is useful in bowel com- 
plaints, as chronic diarrhoea and dysentery. Spiritus Frumenti 
( Whiskey), obtained from fermented grain by distillation, is of about 
the same alcoholic strength as brandy, and may be substituted for 
it ; it does not contain tannic acid. Rum (Spiritus Sacchari), the 
ardent spirit obtained from sugar, is more sudorific than brandy. 
Gin (Spiritus Juniperi) is corn-spirit flavored with oil of juniper; 
and owing to the oil of juniper which it holds in solution, it is an 
active diuretic as well as stimulant and stomachic. Arrack, the 
spirit of Eastern countries, is prepared from a fermented infusion of 
rice. Spiritus Myrci^e (Spirit of Myrcid), bay-nun, the spirit ob- 
tained by distilling rum with the leaves of myrcia acris, is a refresh- 
ing local application. 

The malt-liquors are useful where permanent stimuli are 
called for, as in diseases tending to emaciation, chronic abscesses, 
as well as asthenia, convalescence, and phthisis. In wakefulness 
caused by cerebral anemia^ a glass of ale or beer, at bedtime, is an 
efficient hypnotic. They are contraindicated in all chronic liver 
and renal affections and in disorders of the alimentary canal accom- 
panied with acidity and flatulence, especially in those disorders de- 
pending on the fermentation of food. Although they contain a much 
smaller proportion of alcohol (2 to 6 or 8 per cent.) than the wines, 
yet their habitual ingestion will inevitably cause fatty degeneration 
of the liver and heart, already alluded to. Besides alcohol they 
contain extract of malt, and are, therefore, to some extent, nutritive. 
The best are porter and ale. 

Extractum Malti (Extract of Malt) is official. It is made 
by macerating and then digesting coarsely-powdered malt (the 
seed of Hordeum distichum, or barley (Nat. Ord. Graminaceae) 
caused to enter the incipient stage of germination by artificial means 
and dried) with water, straining and evaporating the fluid thus 
obtained to the consistence of a thick honey. It has a yellowish- 



220 MATERIA MEDICA AND THERAPEUTICS. 

brown color and the sweet taste of malt. It contains some dextrine, 
sugar, bitter and aromatic substances, and is used as a tonic in 
asthenia and neurasthenia. It possesses few advantages over good 
malt-liquors. It is used as a vehicle for cod-liver oil. It aids the 
digestion of starch by promoting its conversion into dextrine and 
glucose. It may be given in doses of f5j-iv after meals. 

AMMONIA PR.&PARATA— PREPARATIONS OF AMMONIA. 

Ammonia (sometimes termed volatile alkali) is a gaseous 
compound of hydrogen and nitrogen (NH 3 ), which is found abun- 
dantly as the result of the decay of organic substances, and is 
usually obtained by the action of lime on sal ammoniac (or am- 
monium chloride). It has a pungent odor, and is very soluble in 
water ; it is a powerful stimulant and local irritant, but is rarely 
used in medicine. 

Incomeatibles. — With the carbonates, the acids vegetable and 
mineral, solution of the acidulous salts, the earthy salts and lime- 
water. 

Aids. — Internally by alcohol, ether, and capsicum ; locally by 
cantharides and blistering agents. 

Physiological Effects. — Locally, ammonia in solution acts 
as an irritant, causing vesication, and after prolonged contact, 
sloughing of the surface. If the gas be sniffed into the upper air- 
passages irritation, sneezing, and a flow of tears ensue. When 
inhaled for any time it produces inflammation of the laryngeal and 
bronchial mucous membranes, and may cause pneumonia Inter- 
nally — Nervous system : when injected into the veins of animals it 
causes convulsions, due to stimulation of the motor-centres of the 
spinal cord and of its reflex functions. Circulation: after intraven- 
ous injections, a momentary fall in the arterial presure takes place, 
followed by a decided and sudden rise (not due to any action on 
the vaso-motor nerves, as it occurs after section of the cord), and a 
corresponding increase in the rapidity of the pulse from stimulation 
of the accelerators of the heart. Blood : it prevents the coagulation 
of the blood, assists in retaining the fibrogenous materials in solution, 
and impairs the function of the red corpuscles as oxygen-carriers. 
Respiration: when injected into the veins the respiratory act is 
greatly accelerated. Elimination : it is probably, to a great extent, 
oxidized in the system, and is eliminated as nitric acid, and perhaps 
as urea, by the kidneys. The effects just described are produced also 



STIMULANTS. 221 

by the following preparations of ammonia, which are employed as 
diffusible stimuli: — 

Aqua Ammoniae Fortior (Stronger Ammonia-Water). This is 
an aqueous solution of ammonia of the specific gravity 0.900. It is 
a colorless liquid, wholly volatilizable by heat, of a caustic, acrid 
taste and has a very pungent odor of ammonia. It is too strong 
for medicinal use internally in its unmixed state, as it contains 28 per 
cent., by weight, of gaseous ammonia. It is a powerful corrosive 
poison, for which the diluted acids, as vinegar or lemon-juice, are 
the antidotes. In the case of a man* who swallowed f5j of it, death 
followed suddenly, his breathing being obstructed, and the lips, 
tongue, uvula and tonsils much swollen, reddened and glazed. It 
is used externally as a vesicant, and has the advantage over cantha- 
rides of a more speedy operation and non-affection of the urinary 
organs, but it is a very painful application. 

Aqua Ammoniae (Ammonia- Water) has a specific gravity of 
O.959, containing 10 per cent., by weight, of ammonia, and is em- 
ployed as a stimulant, antacid and rubefacient. As a stimulant, 
ammonia is admirably adapted for speedily arousing the action of 
the vascular and respiratory systems, as in cerebral anemia, collapse, 
and shock, especially when it is an object at the same time to excite 
the action of the heart. For this purpose it is employed in low 
forms of disease, particularly in the typhoid state, in syncope, 
in asphyxia from narcotic poisons, and to counteract the effects of 
the bites of venomous reptiles. In dyspepsia it is useful with a view 
to the relief of both acidity and flatulence. For internal use other 
preparations of ammonia are generally preferred, and this is used 
chiefly as a rubefacient. Dose, internally, gtt. x-xxx, largely 
diluted. As a rubefacient the official liniment (q. v.) may be used. 

Spiritus Ammoniae (Spirit of Ammonia) is a solution of ammo- 
nia in alcohol, containing 10 per cent, of the gas. It is given as a 
stimulant, antacid and carminative, in the dose of gtt. x-xxx diluted 
with water. But a pleasanter preparation, with similar proper- 
ties, is — 

Spiritus Ammoniae Aromaticus (Aromatic Spirit of Ammonia). 
This is a solution of ammonium carbonate and water of ammonia, 
oil of lemon, oil of pimenta, and oil of lavender flowers, in water and 
alcohol. It is a very agreeable antacid, stomachic and stimulant, and 

* Guy's Hosp. Reports, XVII, 3d ser., p. 225. 



222 MATERIA MEDICA AND THERAPEUTICS. 

may be given in the dose of gtt. xxx to f5j, or more, diluted with 
water. It is useful in alcoholismus as a substitute for liquor when 
the craving for this comes on. 



Ammonii Carbonas [Ammonium Carbonate) (NH 4 HC0 3 NH 4 
NH 2 C0 2 ), being analogous in its effects to those of the preparations 
of ammonia, is considered here. It is prepared by subliming a 
mixture of ammonium chloride and chalk, and consists of a mixture * 
either of one or two molecules of acid ammonium carbonate and 
one molecule of ammonium carbamate. It occurs in whitish, trans- 
parent masses, wholly dissipated by heat, of a pungent, ammoniacal 
odor, an acrid, alkaline taste, and is soluble without residue in 
water. On exposure to air it becomes opaque, falls into powder, 
and deteriorates by the loss of ammonia. 

Effects and Uses. — Its indications are the same as those of 
solution of ammonia, to which it is preferred for internal exhibition 
as a diffusible stimulant. It is especially valuable in pneumonia, 
and by some therapeutists is relied on to the exclusion of other 
medication in this disease. By others it is here regarded service- 
able only as a stimulant ranking after alcohol, and without influence 
to prevent heart-clot (Loomis). The truth seems to be that it is 
adapted only to cases which can be antagonized by its physiologi- 
cal action. It is a useful adjunct to other remedies in the treatment 
of capillary bronchitis ; and in chronic bronchitis with profuse expec- 
toration, diminished strength and impeded cardiac action, its ex- 
hibition, gr. v, every hour or so, is indicated. It has been recom- 
mended in threatened thrombosis, as that of the puerperal state. 
Dose, gr. v-x, in pill or preferably in solution with gum and sugar. 
The fluid extract of glycyrrhiza somewhat disguises its unpleasant 
taste. Mixed with some aromatic oil (as that of bergamot or 
lavender), it is used as a smelling salt in syncope and hysteria. 

AROMATICS. 

Aromatics owe their virtues to the presence of oils obtained 
from them by distillation, and termed volatile oils (plea volatilid), 
sometimes also distilled and essential oils. These oils possess, in a 
high degree, the odor and taste of the plants from which they are 

*" U. S. Dispensatory," 1888, p. 172. 



STIMULANTS. 223 

procured. Locally, they are powerful irritants, and, when taken into 
the stomach in overdoses, act as acrid poisons. They pass partially 
into vapor at ordinary temperatures, and are completely volatilized 
by heat ; hence, decoctions and extracts are improper preparations 
of the aromatics. The distilled oils are inflammable, very slightly 
soluble in water, but soluble in alcohol and ether. Their ultimate 
constituents are, usually, carbon, hydrogen, and oxygen ; and on 
exposure to the air they gradually absorb oxygen, become thicker, 
less odorous, and of a deeper color, and are finally converted into 
resins. The effects and uses of most of the members of this group 
are similar. In medicinal doses they are used as carminatives, and 
are combined with purgatives to prevent griping. Most of them are 
also useful as flavoring ingredients. To many of the volatile oils 
emmenagogue virtues have been ascribed ; but these effects are only 
produced by poisonous doses. Locally, they are used as rubefa- 
cients, antiseptics and to allay neuralgic pains. 

CAPSICUM. 

Capsicum or Cayenne pepper is the fruit of Capsicum fastigia- 
tum and other species of Capsicum {Nat. Ord. Solanaceae), Ameri- 
can tropical plants, naturalized in most warm climates, and cultivated 
in our gardens. C. fastigiatum is a small shrub, with a crooked, 
branching stem, producing in each fork two or three fruits from one- 
half to three-quarters of an inch long, of a subconical form and 
crimson or yellow color. The pods, when dried and ground, 
form capsicum, the best of which is the African, or bird's eye 
pepper, as they contain the most capsaicin. Powdered capsicum 
has a bright-red color, which fades upon exposure to light, an aro- 
matic,|peculiar smell, and a bitterish, acrid, burning taste. An acrid, 
crystalline principle termed capsaicin * (C 9 H 14 2 ), slightly soluble in 
water, but very much so in alcohol and ether, exists in capsicum, 
associated with resin, fixed and volatile oil. 

Contraindications. — Capsicum should not be given in acute 
inflammatory affections of the stomach, intestines or genito-urinary 
apparatus. 

Effects and Uses. — Locally, capsicum acts as an irritant, 
and vesication may be produced by prolonged contact with the 
skin. When applied to the mouth or nose it induces sneezing. 

* Fliickiger, " Pharmacographia, ' 2d ed., p. 454, isolated also a volatile alkaloid having 
the smell of conium, from the seeds and pericarp of capsicum. 



224 MATERIA MEDICA AND THERAPEUTICS. 

Internally. — Circulation : it increases the action of the heart. Se- 
cretion : it stimulates the glands with which it comes in contact, 
and increases the flow of the saliva and the gastric and intestinal 
juices. Elimination: it passes out of the system by the kidneys, 
increasing the flow of urine, and sometimes producing vesical ten- 
esmus and aphrodisiac effects. In large doses it acts as a gastro- 
intestinal irritant. Capsicum is principally employed as a condiment 
and stomachic, and is very useful in torpid conditions of the diges- 
tive organs, or as an adjunct to other remedies to arouse the sus- 
ceptibility of the stomach. Its constitutional effect is not in pro- 
portion to its local effect, and it is, therefore, of no great efficiency 
as a diffusible stimulant. It is a good stomachic in the dyspepsia 
of drunkards ; it also may be given as a substitute for liquor in 
alcoholismns. It is employed as a gargle, and also as a cataplasm 
to cause counterirritation. Dose, of the powder, gr. v-x, in pill; 
of the tincture (5 parts to diluted alcohol 95 parts), TVLx-f5j ; of the 
fluid extract, Til v-x. The oleo-resin is a powerful rubefacient, and 
may be given internally in the dose of gr. ss-j. A plaster is also 
official. 

PIPER— PEPPER. 

Black pepper is the unripe fruit of Piper nigrum {Nat. Ord. 
Piperaceae), a vine of the East Indies. The berries are gathered be- 
fore they are quite ripe, cleansed by washing and sifting, and dried 
in the sun, when they are known as shot-pepper. They are wrinkled 
and black, in consequence of the drying of the pulp over the gray- 
ish-white seed, and in this state are known as black pepper. If per- 
mitted to ripen, and soaked in water till the outer coat is removed, 
they constitute white pepper. Pepper has an aromatic, peculiar 
odor and a hot, spicy, pungent taste. Its properties are taken up by 
alcohol and ether, and partially by water. It contains a volatile oil, 
an acrid resin, to which the pungent taste of the drug is due, and a 
crystalline neutral alkaloid of feeble power, called piperine (Ci 7 H 19 - 
N0 3 ), isomeric with morphia, which is used as an antiperiodic 
remedy. 

Effects and Uses. — In warm-blooded animals piperine re- 
duces the number of respirations, increases the frequency of the car- 
diac beats (apparently from paralysis of the vagus-center), dilates 
the pupils widely, and arrests the heart in systole. The effects of 
pepper are similar to those of capsicum. It is a warm carminative 
stimulant, chiefly employed as a condiment, but it is also useful as 
a stomachic in dyspepsia. Dr. C. S. Taylor reports success with 



STIMULANTS. 225 

piperine in the treatment of intermittent fever where quinine had failed, 
or the idiosyncrasy of the patient would not permit its employment. 
Dose, gr. v-xx. Of the oleo-resiu the dose is gr. ss-ij. Piperina 
{piperine) may be prescribed in doses of gr. ij-x. 

CINNAMOMUM— CINNAMON. 

There are two varieties of cinnamon — Ceylon cinnamon, which 
is the inner bark of the shoots of Cinnamomum zeylanicum, a tree 
of Ceylon and Java ; and China cinnamon, or cassia, the bark of 
the shoots of one or more undetermined species of Cinnamomum 
(Nat. Ord. Lauraceae), trees of China. The most esteemed is the 
Ceylon cinnamon. It is found in the shops in long, cylindrical 
pieces, which are very thin and smooth, and of a yellow-brown 
color and a splintery fracture. It has a fragrant odor and a warm, 
sweetish, aromatic, slightly astringent taste. Its constituents are 
volatile oil, tannic acid, mucilage, sugar, mannit, etc. The greater 
part, however, of the cinnamon brought to this country is the cassia 
cinnamon. It has the general appearance, smell and taste of true 
cinnamon, but the pieces are not doubly quilled. Its properties are 
identical with those of the Ceylon variety. 

Effects and Uses. — Cinnamon is an aromatic stimulant, with 
a slight astringency. It is used chiefly as a carminative, and as an 
addition to other medicines. Dose, gr. x-xxx; of the tincture 
(io parts alcohol and water enough to make ioo parts of tinc- 
ture), the dose is f 5j-iij. Oleum Cinnamomi (oil of cinnamon) is of 
a light-yellow color, which deepens by exposure to the air, with 
the development of an acid, termed cinnamic ; dose, gtt. i-ij. 
Aqua cinnamomi (cinnamon-water) is used as a vehicle for other 
medicines. Spiritus Cinnamomi (spirit of cinnamon) contains IO 
parts of the oil dissolved in 90 parts of alcohol; dose, gtt. x-xx. 
Cinnamon enters into a large number of preparations. 

MYRISTIC A— NUTMEG. 
MACIS— MACE. 

The products are portions of the fruit of Myristica fragrans 
(Nat. Ord. Myristicacese), a tree of the Moluccas, cultivated also 
in Java and Sumatra and other parts of the East Indies, and 
introduced into the isles of France and Bourbon and several of 
the West India islands. It bears a pyriform fruit about the size 
of a small peach, which has a fleshy pericarp, opened by two 
15 



226 MATERIA MEDICA AND THERAPELTICS. 

longitudinal valves. Within this is the arillus, a scarlet reticu- 
lated membrane, which, when dry, becomes yellow-brown and 
brittle, and is termed mace. The kernels of the seed are the 
nutmegs. They are oval, of the size of an olive, of a grayish-brown 
color, marked with furrows ; and to preserve them from the attacks 
of an insect, they are steeped in a mixture of lime and water. 
Mace has a pleasant, aromatic smell and a warm, bitterish, pungent 
taste. Nutmegs have a delightfully fragrant odor and a warm, 
aromatic, grateful taste. Nutmeg contains a volatile oil (consisting 
of myristicene, C 10 H 16 , and a little myristicoll, (C 10 H u O), fixed oil 
(25 per cent), starch, pi'oteids, etc. From mace, also, a volatile oil, 
etc., is obtained. 

Effects and Uses. — Nutmeg is one of the most agreeable of 
the aromatic stimulants, and is much employed for its carminative 
virtues, also as a flavoring ingredient, and to obviate the griping 
effects of cathartics. It possesses narcotic properties. This was 
exemplified in the case of a child who fell into profound slumber 
after having eaten five large nutmegs.* Mace is chiefly employed as 
a condiment. Dose of either, gr. xx-xxx. Oleum myristicce (oil 
of nutmeg) is of a pale straw-color; dose, gtt. ij-iij. Spiritus my- 
risticce is made by dissolving 3 parts of the oil in 97 parts of alco- 
hol; dose, f5j-ij. The fixed oil of nutmeg is known in the shops as 
oil of mace, adeps myristicce (not official) ; it is used in liniments. 

CARYOPHYLLUS— CLOVES. 

Cloves are the unexpanded flowers of Eugenia caryophyl- 
lata (Nat. Ord. Myrtaceae), an evergreen tree of the Moluccas. 
They are from five to ten lines long and from one line to one line 
and a half thick, the corolla forming a ball or sphere at the top, 
and the calyx a tapering, somewhat quadrangular base, resembling 
a nail, whence the common name, from the French, clou. When 
good, they are of a dark-brown color, with a yellowish-red tint; 
they have a strong, fragrant odor, a hot, acrid taste, and when 
pressed with the nail, should give out oil. They contain a highly 
pungent volatile oil, tannic acid, resin, etc., and two crystalline prin- 
ciples, termed caryophillin and eugenin; the oil consists of a hydro- 
carbon (C 10 H 16 ) and a colorless oil termed eugenol or eugenic 
(Ci H 12 O 2 ). 



* N. Y. Med. Jour., Sept. 28, 1889. 



STIMULANTS. 227 

Effects and Uses. — Cloves are among the most stimulating 
of the aromatics, but are used chiefly as a flavoring ingredient and 
a condiment. Dose, gr. v-x. The oil, oleum caryophylli, is pale or 
yellowish, becoming darker by age; dose, gtt. iij-vj. 

PIMENTA. 

Pimenta, called also Allspice, is the unripe berries of Eugenia 
Pimenta [Nat, Ord. Myrtaceae), a handsome evergreen tree of the 
West Indies and South America. It comes exclusively from Ja- 
maica, and consists of round, brown, roughish berries, rather 
larger than black peppercorns, with an external hard, brittle shell, 
enclosing two dark-brown seeds. They have an aromatic, agree- 
able smell and a strong clove-like taste. They are principally used 
as a condiment. The oil, oleum pimenta, has a brownish-red color, 
and consists of a hydrocarbon and eugenic acid; dose, gtt. iij-vj. 

Oleum Cajuputi [Oil of Cajeput). The volatile oil distilled 
from the leaves of Melaleuca cajuputi [Nat. Ord. Myrtaceae), a 
tree of the Moluccas, is a powerful diffusible aromatic stimulant, 
much employed in Eastern countries, and of late coming into 
use in the United States. It is a transparent oil, of a fine green 
color, a lively, penetrating odor, analogous to that of camphor and 
cardamom, and a warm, pungent taste. It is an admirable remedy 
for the relief of nausea -and intestinal colic, and is added as a car- 
minative to purgative pills to prevent griping; dose, gtt. j-v. 

ZINGIBER— GINGER. 

Ginger is the rhizome of Zingiber officinale [Nat. Ord. Zin- 
giberaceae), a perennial herbaceous plant, growing to the height of 
two or three feet. Its native country is Asia, where it has been 
cultivated from time immemorial, and was early introduced into the 
tropical regions of America. Ginger-root occurs in flattish, jointed, 
branched or lobed pieces, which rarely exceed four inches in length. 
In the young state, the roots are preserved in sugar, and form a 
very pleasant sweetmeat. When old, they are taken up, scalded in 
hot water, and dried, when they are known as black ginger. Some- 
times they are scraped previously to being dried, and are then 
called white ox Jamaica ginger. Both varieties have a powerful 
odor and a warm, pungent, aromatic taste. They impart their 
virtues to water and alcohol, and contain a pale-yellow volatile oil 
ginger ol (to which the hot taste is due), resin, starch, etc. 



228 MATERIA MEDICA AND THERAPEUTICS. 

Effects and Uses. — Ginger is a pungent, aromatic stimulant, 
much employed as a stomachic in flatulency, dyspepsia, and colic 
of the stomach and bowels. It is used also as a condiment, and to 
correct the unpleasant taste and nauseating qualities of other med- 
icines. A paste made of the powder and warm water is used as a 
counterirritant. Dose, gr. x-xx, in pill. The official preparations 
are : tincture — dose f 5ss-j ; fluid extract — dose, gtt. xx-xxx ; syrup 
— used as a vehicle for other medicines ; oleo-resin — dose, gtt. j-ij ; 
and troches (made by mixing the tincture with tragacanth, sugar, 
and a little syrup of ginger). 

CARDAMOMUM- CARDAMOM. 

Cardamom is the fruit of Elettaria Cardamom um {Nat. Ord. 
Zingiberaceae), a perennial plant, from six to nine feet high, found 
in the mountainous parts of Malabar. Three varieties of Malabar 
cardamoms are known in commerce : shorts, short-longs, and long- 
longs, all furnished by the same plant. They are ovate-oblong, 
from three to ten lines long, coriaceous, ribbed, and of a grayish 
or brownish-yellow color, and contain a number of blackish or 
reddish-brown seeds, which have a pleasant, aromatic odor and a 
warm, aromatic, agreeable taste. They yield a colorless volatile 
oil, a fixed oil, starch, etc. 

Effects and Uses. — Cardamom is a very agreeable aromatic, 
devoid of acridity, and is employed as a stomachic and carmina- 
tive, and as an adjuvant and corrective of other medicines; dose, 
gr. v-x. The tincture (15 parts to diluted alcohol 85 parts) is the 
preparation chiefly used; dose, f5j-ij. The compound tincture con- 
tains cardamom, and also caraway, cinnamon, cochineal, diluted 
alcohol, and glycerin. Free acids separate insoluble carminic acid 
in the latter preparation. 

Pulvis Aromaticus (Aromatic Powder) consists of cinnamon 
and ginger, each 35 parts, and cardamom and nutmeg, each 15 parts. 
It is used as a carminative in doses of gr. x to xxx. 

Extractum Aromaticum Fluidum (Aromatic Fluid Extract) is 
a fluid extract of aromatic powder. It is chiefly used as a flavor- 
ing ingredient in mixtures, but may be used where aromatic powder 
is indicated in doses of f5ss-j or more. 

CALAMUS 

The Rhizome of Acorus calamus or Sweet Flag (Nat. Ord. 
Araceae), an indigenous marshy plant, with long, sword-shaped, 



STIMULANTS. 



229 



radical leaves (giving out a delicious fragrance when rubbed), is a 
valuable aromatic stimulant, with some tonic properties. Accord- 
ing to Cadeac and Meunier,* the essential oil has a special affinity 
for the nervous system, being a powerful convulsive and tetanizing 



Fig. 18. 




ACORUS CALAMUS. RHIZOME. 



agent and dangerous when mixed with liquors. The rhizome is 
found in the shops in somewhat flattened pieces, deprived of their 
epidermis, wrinkled, and of a yellowish color, and has a strong, 



* Compt. Rend. Soc. de Biol. Ser. 9 ; Paris, 1890, p. 509. 



230 MATERIA MEDIC A AND THERAPEUTICS. 

fragrant odor and a warm, bitterish, aromatic taste. It contains 
volatile oil, acorin (probably a glucoside), resin, starch, etc. Dose, 
gr. xx to 3j. A fluid extract is official; or it may be given in 
infusion. 

GAULTHERIA. 

Gaultheria procumbens, Partridge-berry, Deer-berry, or Tea- 
berry (Nat. Ord. Ericaceae), is a small indigenous evergreen plant, 
with reddish stems, a few inches in height, bright-green leaves, and 
white, ovate, five-toothed flowers, followed by scarlet berries. The 
leaves are the official portion, and contain a very stimulating 



Fig. 19. 




GAULTHERIA PROCUMBENS. LEAVES,. 

volatile oil (oleum gaidtherice), which, when first distilled, is color- 
less, but gradually becomes reddish, and is distinguished as being 
the heaviest of volatile oils. It consists of gaultherilene (C 10 H 16 ) 
T V part, and methyl salicylate (CH 3 C 7 H 5 3 ) T 9 o parts. The leaves 
also contain arbutin, ericolin, urson, tannin, sugar, etc. The official 
preparations are the oil and the spirit (containing 3 parts of the oil 
in 100 of the preparation). An infusion of the leaves is in very 
general popular use as a carminative and stomachic. 



STIMULANTS. 231 

Toxicology. — Dr. Pinkham* reports four cases of poisoning 
by oil of gaultheria, in which fSss was the fatal dose in each. In 
all severe symptoms of irritation of the gastro-intestinal tract and 
disturbance of the cerebral functions were noted. It seems to be a 
narcotico-irritant poison. 

Effects and Uses. — The oil of gaultheria possesses antipyretic 
powers about equal to those of sodium salicylate, and it has been 
used for this purpose with considerable success in acute rheumatism. 
Dr. Kinnicutf reports twelve cases treated by it with the following 
results: Complete absence of pain in about three days; duration of 
fever, 3^ days; average stay in hospital, 24^ days. GottheilJ 
finds that it reduces the local swelling and relieves the pain (four 
cases); while A. Flint, Sr.,§ states that the average length of con- 
finement to hospital was, in eleven cases, less than five days — a very 
favorable showing. All of these observers gave it in frequently 
repeated doses (gtt. x), Flint in flaxseed tea. 

AURANTII AMARI CORTEX— BITTER ORANGE-PEEL. 
AURANTII DULCIS CORTEX— SWEET ORANGE-PEEL. 

The rind of the fruit of Citrus vulgaris, or Bitter Orange, 
and Citrus aurantium, or Sweet Orange (Nat. Ord. Auranticeae), 
is much employed as a flavoring addition to other medicines. 
They contain volatile oils, hesperidin (a bitter crystalline glucoside), 
etc. The flowers (aurantii flores) yield a delightful volatile oil 
termed oil of neroli (official), consisting of a hydrocarbon and 
some neroli-camphor. The following are the official prepara- 
tions: orange-flower water (aqua aurantii florum), an agreeable 
vehicle, possessing slight antispasmodic virtues ; syrup of orange- 
flowers and syrup of orange are used as excipients and vehicles for 
medicines of unpleasant flavor ; oil of orange-peel ; fluid extract of 
bitter orange-peel ; spirit of orange ; elixir of orange-peel. The 
tincture of bitter orange-peel and tincture of szveet orange-peel may 
be given in doses of f5j-ij- 

The following aromatics, of the natural order Labiate, are 
pleasant carminatives and stomachics : — 

Lavandula (Lavender). The flowers of Lavandula vera, a 
small European shrub, cultivated in our gardens, about two feet 
high, with fragrant blue flowers, which are gathered in June, and 

* Boston Med. and Surg, yourn, Dec. 8th, 1887. 
fvV. Y. Med. Record, 1882, p. 505. % Ibidem, 1883, p. 256. \ Ibide?n } 1883, p. 725. 



232 MATERIA MEDICA AND THERAPEUTICS. 

dried in the shade. They have an agreeable fragrant odor and a 
pungent, bitter taste. They contain volatile oil, resin, a little tannin, 
etc. The oil {oleum lavandulce florum), which is of a pale-yellow 
color, or the oil of lavender {oleum lavandidce) — a volatile oil dis- 
tilled from the whole herb), may be used in the dose of from gtt. 
j-v. But the preferred preparations are the spirit {spiritus lav- 
andulce) and the compound tincture {tinctura lavandidce composite?), 
which contains also oil of rosemary, cinnamon, cloves, nutmeg, and 
red saunders; dose, f5j. 

Mentha Piperita {Peppermint) and Mentha Viridis {Spearmint) 
are European plants, naturalized in the United States. The leaves 
and tops are employed; they have an aromatic odor and a pungent, 
somewhat bitter taste, followed by a sensation of coolness. Mentha 
viridis contains a volatile oil, gum, resin, etc.; Mentha piperita a 
volatile oil (consisting of Ci H 18 O and a crystallizable substance 
termed menthol* C 10 H 20 O), a little tannin, resin, etc. 

Braddon f has recently called attention to the antiseptic pro- 
perties of peppermint oil, and he experimentally found it (up to 
i to 3000) to be superior, in the prevention of decomposition, to 
such agents as corrosive sublimate and carbolic acid. For minor 
surgical operations he used successfully gtt. j to olive oil f 5j soaked 
in lint. In this form it is packed into sinuses, and suppurating bu- 
boes, and applied to ideers, and rupia, being retained by a strip of rub- 
ber plaster. The results obtained by him with the inhalation of the 
pure oil, as a germicide in phthisis, are scarcely conclusive, though 
in some cases it seemed to be beneficial. The oils may be given in 
doses of gtt. x-xx-xl: useful in flatulent dyspepsia, given after 
meals. Two waters are also official {aqua mentha? piperitce and 

* MENTHOL {Mint- Camphor) is obtained by the fractional distillation of the oil of 
peppermint, and to it the oil owes its peculiar odor. It occurs in colorless prisms which 
are said to correspond to the Chinese solid oil of peppermint, It has, of late years, 
been extensively used as an anodyne application in the treatment of neuralgic pains, espe- 
cially those occurring in the supra orbital and temporal regions, as headache, but is equally 
efficient in neuralgias affecting other regions. It is also recommended for the relief of 
rheumatic pains, It is found in the shops in cones or pencils under the name of Menthy- 
lene, etc,, but the best preparation for external use is a solution in alcohol ( 5 J of the pure 
crystals to f5ss) painted over the part with a brush. 

A. Rosenberg* uses menthol 20 parts to ether 100, or 50 of alcohol, as a substitute for 
cocaine to produce local anaesthesia of the nasal cavities and pharynx, He finds that it 
induces anemia of the mucous membrane and diminution of sensibility. 

| The Lancet, March, 1888, pp. 512, 567. 



* Central, filr gesamt. therap., Oct., 1886, p. 441, 



STIMULANTS. 233 

aqua menthce viridis, both much used as vehicles). The oil of 
peppermint is the stronger of the two, and is strongly recom- 
mended as an anodyne application in allaying the neuralgic pains 
of herpes zoster* TrocJies of peppermint are made by rubbing up 
oil of peppermint with sugar and mucilage of tragacanth. 

Vinum Aromaticum. (Aromatic wine) is made by percolation, 
and contains I part each of lavender, origanum, peppermint, rose- 
mary, sage, and wormwood, with sufficient stronger white wine to 
make the filtered liquid weigh ioo parts. 

Rosmarinus (Rosemary ».) Rosmarinus officinalis, or Rosemary, 
a European evergreen shrub, cultivated in our gardens, contains a 
very stimulant volatile oil (oleum rosmarinus) which is chiefly used 
as an ingredient of rubefacient liniments. It is also used in making 
spiritus odoratus (cologne-water). The leaves are used. They 
enter into vinum aromaticum. 

Hedeoma (Pennyroyal}. Hedeoma pulegioides, or Pennyroyal, 
is an indigenous annual plant, about a foot high, with oblong lance- 
olate, serrated leaves, and small, pale-blue flowers arranged in axil- 
lary whorls. The leaves and tops are used, which contain a light- 
yellow essential oil, similar in properties to the mint-oil, but some- 
what more powerful. A body, termed hedeomol (Ci H 18 O), has been 
extracted from the oil by Franz, f of which it constitutes 33 per 
cent. 

Origanum. The herb of Origanum vulgare, or common Mar- 
joram. The essential oil is an ingredient in stimulating liniments, 
but is not official. Origanum enters into vinum aromaticum. Han- 
bury states that the oil of origanum of the shops is only oil of thyme. 

Marrubium (ITorehound). Marrubium vulgare possesses mild, 
stimulant, tonic and expectorant properties, and, in large doses, 
proves laxative. It is used chiefly in cough syrups and candies. 
The leaves and tops are employed. 

Salvia (Sage). The leaves of Salvia officinalis, a European 
plant, cultivated in our gardens, are used as a condiment, and may 
be given in infusion as a gargle in pharyngitis ; they are slightly 
tonic and astringent, as well as aromatic. It is an ingredient of 
vinum aromaticum. 

Oleum Thymi (Oil of Thyme). The volatile oil distilled from the 



* The Practitioner, London, August, 1882, Meredith, 
"f" Am. Tour, of Phartn., April, 1888, p. 161. 



234 MATERIA MEDIC A AND THERAPEUTICS. 

Thymus vulgaris is often substituted for oil of origanum, and is 
used as an external application. The oil of thyme consists of 
cymene (Ci H 14 ), thymene (C l6 H 16 ), and thymol (Ci H H O), occurring 
in highly aromatic colorless crystals, and has been found a valuable 
antiseptic and antifermentative agent (see Antiseptics). 

The following aromatic seeds are derived from plants of the 
natural order Umbellifer^e : — 

Foeniculum {Fennel). The fruit of Foeniculum vulgare, a 
European plant, cultivated in our gardens. It may be used in in- 
fusion ; the dose of the oil is gtt. v-xv. Fennel-water is official. 

Carum [Caraway). The fruit of Carum Carvi, a European 
plant, cultivated in this country. Dose of the oil, gtt. j~-x. 

Anisum [Anise). The fruit of Pimpinella anisum, cultivated 
throughout the south of Europe. Dose of the oil, gtt. v-xv. Anise- 
water (aqua anisi) and spirit of anise are also official. 

Coriandrum (CoiHander). The fruit of the Coriandrum sativum, 
an annual plant of the south of Europe. The oil is official. 

Illicium (Star Anise). The fruit of the Illicium anisatum 
(Nat. Ord. Magnoliaceae), an evergreen tree of China and Japan is 
official. It contains a volatile oil (which is chemically identical with 
the oil of anise, but has a slightly different odor and taste), fat, resin, 
etc. (Maisch). The oil possesses analogous properties to those of 
the oil of anise, and is much used as a substitute for it. 

VANILLA. 

This is the fruit of Vanilla planifolia (Nat. Ord. Orchidaceae), 
a climbing plant of Cuba and Mexico, cultivated also in various 
parts of tropical America, in the Mauritius, Reunion and Java. 

The pods, when gathered, are yellow, but by exposure to the 
sun they assume a dark copper color. They are cylindrical, some- 
what flattened, wrinkled, six or eight inches long, three or four 
lines thick, and contain a soft black pulp, in which numerous small 
black seeds are embedded. Vanilla has a strong characteristic, 
highly pleasant odor, and a warm, aromatic, sweetish taste ; the in- 
terior pulpy portion is most aromatic. The odorous principle of 
vanilla is a crystalline substance termed vanillin (C 8 H 8 3 ), which 
can be made synthetically from coniferin ; it is found only in the 
interior and not in the exterior fleshy portion. It is a mild diffusible 
stimulant, chiefly used, however, as a perfume and flavoring ingre- 
dient. The tincture is official. 



SEJPA TIVES—A CONITE. 235 

ORDER VII.— SEDATIVES. 

Sedatives are medicines which diminish the frequency of the 
action of the circulation. They are employed therapeutically to re- 
duce excitement of the vascular system. 

With sedatives may be included also the medicinal agents 
termed refrigerants, comprising nearly all the neutral alkaline salts, 
as well as those in which the acid predominates, and the vege- 
table acids. These substances have little power of diminishing the 
ordinary or healthy temperature ; but they lower febrile heat, allay 
thirst, restore the secretions, and in this way are very useful adju- 
vants in the treatment of febrile complaints. 

ACONITUM-ACONITE. 

Aconitum Napellus, Aconite, Wolfsbane, or Monkshood [Nat. 
Ord. Ranunculaceae), is a native of the mountainous parts of Europe 
and Asia. The tuberous root is the official portion. It is 
brought from Europe, India, and Japan, and other species of 
Aconitum than A. Napellus furnish some of the aconite of commerce. 
Its taste is bitterish and acrid, and when chewed occasions a 
peculiar feeling of tingling and numbness in the tongue and 
interior of the mouth. These properties are impaired by long 
keeping, when the plant loses its medicinal efficacy. 

Chemical Constituents and Tests. The active principle of 
aconite is an alkaloid named aconitine (C3 3 H 4 3N0 12 ). Four other 
alkaloids, pseudaconitine (C 36 H 49 NOn), aconine (C^H^NOu), pseud- 
aconine (C 27 H 41 N0 8 ), and pier aconitine (C^Yi^O^, have been found 
in it, but the chemistry of aconite is not well settled. 

Aconitine exists in combination with a peculiar acid termed 
aconitic, and is prepared from an aqueous solution of an alcoholic 
extract of aconite-root, by the addition of sulphuric acid (which 
converts the natural salt of aconitine into a sulphate). It is a white 
amorphous powder, with a tinge of yellow (though it has been 
obtained in crystals), without smell, of a bitter, acrid taste, and pro- 
duces in the mouth a sense of numbness. It is partially soluble in 
water, and is readily dissolved by alcohol and chloroform, less 
readily by ether. There is no characteristic chemical test for aconi- 
tine, but a strong aqueous solution of hydrobromic acid saturated 
with bromine throws down the aconite salts, or aconite itself, as a 
yellow precipitate, even if it be present in minute quantity (-rshrs, 



236 



MATERIA MEDICA AND THERAPEUTICS. 



Wormley) in medico-legal cases, the physiological test, by pro- 
ducing numbness and tingling of the lips or skin, must be resorted 
to. As aconitine is easily decomposed, the commercial article is 
more or less impure. 

Wright and Luff* isolated from the roots of Japanese aconite 
only one alkaloid, japaconitine, which can be split into japaconine, 
both of which closely resemble aconitine and aconine in physical 
properties. 

Aconitine is an exceedingly virulent poison, more powerful 
when pure than hydrocyanic acid. It is scarcely adapted to internal 

Fig. 20. 





mix 



ACONITE-ROOT. 



use, as even gr. ^0 has produced alarming results. Morson's aconi- 
tine, prepared from the cultivated A. Napellus, is terribly potent, 
even gr. T oW producing numbness of the tongue. 



Journal of Chemical Society, vol. i, p. 387, 1879. 



SEDA TIVES—A CONITE. 237 

Aids. — Veratrum viride, veratria, cold, quinine, pulsatilla, 
Phytolacca and cardiac depressants generally. 

Contraindications. — Debility of the circulatory apparatus; 
cardiac valvular lesions with regurgitation. 

Physiological Effects. — Aconite applied locally causes a sensa- 
tion of numbness and tingling, induced by its benumbing effect on 
the sensory nerves. The following account of the action of 
aconite is based on the investigations of Mackenzie,* Laborde et 
Duquesnel,f and of Plugge.J Nervous system : taken in small 
doses aconite exerts no influence upon the cerebrum, but its taste is 
pungent and benumbing, and it produces a feeling of numbness in 
the head, face, and extremities. Aconite has no action upon the 
motor-nerves, the loss of reflex action caused by it being due to 
paralysis of the sensory end-organs, extending to the nerve-trunks, 
and finally to the spinal sensory centres. The spinal motor-centres 
are only involved when total palsy has set in. Circulation : aconite 
exerts a marked influence on the circulatory apparatus, small doses 
reducing the heart's action and lowering the arterial pressure ; 
lethal doses stop the heart in diastole. Aconite applied to the 
heart slows it so that it may be concluded the drug is a cardiac 
poison acting directly on its motor ganglia. It is also believed to 
stimulate the cardiac inhibitory apparatus. According to the 
researches of Ringer and Murrell, aconite paralyzes all nitrogenous 
tissues, and it is in this way that the heart's beats are retarded. In 
other words, it acts directly against the heart's contained motor- 
apparatus. Respiration : these movements tend to become slow, 
and the temperature is lowered. Secretions: aconite increases the 
secretion of the skin and kidneys, and is probably eliminated by the 
latter. 

Toxicology. — In lethal doses, its effects are those of an acro-nar- 
cotic poison, the symptoms being a burning or benumbing sensation 
in the mouth, throat, and tongue, followed by gastric irritation, 
spasmodic purging, short, shallow, and superficial respirations, con- 
traction or expansion of the pupils, though dilatation is the rule ; 
numbness or paralysis of the limbs ensues, the skin is cold and 
clammy, convulsions set in, the pulse fails, and death results from 
syncope. Aconitized animals remain conscious until death takes 



* The Practitioner, xx, i878, pp. ioo, 185. 
I Revue de Med., iii, I883, p. 804. % Ibidem, p. 1045. 



238 MATERIA MEDIC A AND THERAPEUTICS. 

place. In several instances a drachm of the tincture has destroyed 
human life. 

Antidotes. — In case of poisoning, the stomach is to be thor- 
oughly evacuated, and cardiac stimulants, externally and internally, 
are to be freely administered. The object of physiological antidotes 
being to keep the heart acting, hypodermics of atropine sulphate 
and aqua ammoniae will be found powerful excito-motors for this 
purpose. Digitalis is advised by Fothergill. 

Medicinal Uses. — Aconite is a powerful remedy in the treat- 
ment of neuralgic? \ especially when the 5th pair of cranial nerves are 
affected. It is often combined with quinine in these cases, and 
should be given in doses sufficient to produce its characteristic 
physiological effects to a slight degree. A local application of the 
tincture or of a liniment or ointment is often resorted to with ad- 
vantage, while the drug is administered internally. 

From its influence on the circulation it is applicable to those 
cases of inflammation in which general bloodletting was formerly 
resorted to with advantage, as it slows the pulse-rate and lowers 
the arterial tension, at the same time reducing the temperature 
and causing diaphoresis and diuresis. 

Thus it is applicable in all cases of sthenic inflammatory fever, 
occurring in robust young adults with a full, tense, bounding, strong 
and frequent pulse, and does most good before the effusion of inflam- 
matory products has taken place. It is not so efficacious, however, 
in typhoid conditions of the system, where the heart is weak or 
where there exists any acute inflammation of the gastro-intestinal 
mucous membrane. 

Its timely administration may be of much service to control 
cardiac action in apoplexy and so prevent further hemorrhage, to 
calm or hold in check the circulatory apparatus in vascular excite- 
ment } and congestion, and to be beneficial in these conditions it 
should be given in doses large enough to make its influence felt. 

In surgical fever it is better given in small doses, frequently re- 
peated until its effects on the pulse are manifested, when the interval 
between the doses should be increased, and it may be administered 
either alone or combined with other remedies, as in the following 
fever mixture: B Morphinae sulphatis, gr. j-ij ; tincturae aconiti, 
Tftxxiv; potassii acetatis, Sss; spiritus setheris nitrosi, f5yj; liquoris 
ammonii acetatis, f§iss; syrupus limonis, ad fSiij. M. S. — f5j m 
water every 2, 3 or 4 hours as indicated. 



SEDA Tl J ES—A CONITE. 239 

Aconite may be prescribed in this way and for these effects, not 
only in surgical fevers but also in idiopathic inflammatory conditions, 
provided the indications for its employment are present. In acute 
tonsillitis it will not infrequently cut short the attack if administered 
in time; in acute pharyngitis , acute laryngitis or acute bronchitis, it is 
of undoubted value when given early, in small doses and frequently 
repeated. An incipient coryza may be aborted by the timely use of 
aconite, given as above, until the pulse is reduced in volume and 
frequency, although for this purpose veratrum viride is generally 
preferred. In the early stages of acute otitis media, if the circulation 
be excited, much relief may be obtained by a combination of 
aconite with morphine and potassic bromide, and the external ap- 
plication of heat. In certain diseases of the respiratory organs, 
aconite is of great value, not only from its action on the circulation, 
but because it slows the respiratory act. Thus in acute pleurisy 
before the stage of effusion has been reached, if the patient be strong 
and robust and the pulse full and bounding, tincture of aconite 
gtt. j should be given every 15 or 20 minutes, until the pulse is in- 
fluenced, while morphine (gr. \-£) should be administered hypoder- 
mically, and wet or dry-cups freely applied to the affected side, 
followed by a large poultice. 

In acute catarrhal pneumonia aconite is also beneficial, and even 
in the first stage of lobar pneumonia it may be cautiously adminis- 
tered combined with some of the ammonium salts, but it must be 
discontinued as soon as effusion has taken place. It possesses no 
advantage over veratrum viride in these cases, and the latter is 
probably the safer remedy. 

In phthisis, when the disease tends to spread, it may be given 
cautiously, to reduce the pulse-rate and moderate the fever. 

In acute peritonitis aconite is of the greatest value and should be 
combined with large doses of opium. In those forms of peritonitis 
occurring during the puerperal period and due to septic infection, 
aconite is contraindicated, a supporting and antiseptic plan of treat- 
ment giving better results (see puerperal septicemia, under quinine). 

In acute cerebral or acute spinal meningitis aconite is also of 
great value. It is indicated in many of the essential fevers, as in 
febricula, in which disease a fever mixture containing aconite, and 
the administration of small doses of calomel, frequently cut short 
the attack. 

To moderate the excessively rapid pulse of scarlatina, as well 



240 MATERIA MEDIC A AND THERAPEUTICS. 

as for its antipyretic, diaphoretic and diuretic action, aconite is of 
the greatest utility. In measles, also, and in sthenic cases of med- 
ical erysipelas it has been advantageously prescribed. 

In the early stages of cerebrospinal fever before exudation has 
taken place, it may be given with large doses of opium and potassic 
bromide, while the local abstraction of blood by leeches, followed 
by cold to the head and neck is employed. 

To moderate the fever and pulse in the hot stages of inter- 
mittent and remittent fever, aconite is also used, and in the latter 
affection it is often efficacious in relieving the intense headache 
which so frequently accompanies this stage. 

From its effects on the heart itself aconite is of- the greatest 
value in cases of cardiac hypertrophy when not compensatory to valvu- 
lar lesion. In cases of simple hypertrophy, palpitation and over-action, 
it is our most available remedy combined with rest in the recumbent 
posture, but should any valvular disease exist, great caution must 
be exercised in prescribing it. In cerebral hyperemia of active type, 
by diminishing the force and frequency of the cardiac contractions, 
it proves most beneficial. 

It has also been resorted to in the treatment of internal 
aneurism as a cardiac sedative. 

Aconite is recommended in amenorrhea from taking cold, but 
is not always successful. 

In congestive dysmenorrhea it has also been employed, but 
possesses no advantage over other remedies. 

It has also been recommended to check the vomiting of preg- 
nancy. 

As a topical anodyne, aconite, as might be inferred from its 
local benumbing action, is a most useful remedy in neuralgice and 
chronic rheumatism, either painted over the part in the form of a 
tincture or applied as a liniment or ointment, and sometimes when 
thus used it has a marked beneficial effect. Admixture with chloro- 
form aids the absorption of its alkaloid, and thus enhances its 
effect; but when thus used it should be employed with care and 
not applied to too large a surface for fear of too rapid absorption.* 

Aconitine has been used internally and locally in the treatment 
of tic douloureux and other forms of trigeminal neuralgia. Du- 



* "A Text-Book of Pharmacology, Therapeutics and Materia Medica. "By T. Lauder 
Brunton, M. D., etc. London : 1885, p. 753. 



SEDATIVES— VERATRUM VIRIDE. 241 

quesnel's aconitine is preferred for internal administration in doses 
of t&o-ihr- It is a ver y active poison, and if employed at all, should 
be used with the greatest care. 

Locally, it is used in neuralgia, as sciatic, ox facial, in alcoholic 
solution (gr. j-ij to alcohol f5j), or as an ointment (gr. ij to lard 5j, 
rubbed up with alcohol gtt. vj). When applied to the temple or 
brow great care should be exercised to prevent any from coming in 
contact with the conjunctiva, as absorption from the membrane is 
very rapid and may occasion poisoning. 

Administration. — The dose of the powdered root is gr. ^ to 
j ; of the abstract, gr. y 2 to j ; of the fluid extract, TTL 1-iij ; of the 
extract (alcoholic), gr. %-% \ °f tne tincture, which is by far the 
best preparation (400 parts of the powder are contained in 1000 
parts of the tincture), TTL %-v. These doses are to be repeated 
twice or thrice daily, and cautiously increased till the effects of the 
medicine are apparent, or in acute febrile affections the smaller 
doses may be given and repeated every 15 to 30 minutes until the 
pulse is influenced or diaphoresis occurs. The tincture may be 
used externally. 

VERATRUM VIRIDE. 

Veratrum viride, known as American Hellebore, Swamp Hel- 
lebore, Poke-root, Indian Poke, etc., (Nat. Ord. Melanthaceae), is 
a swampy plant, indigenous to the eastern portion of the United 
States, growing to the height of from three to six feet. The 
rhizome and rootlets are the official portions. The rhizome is 
an inch or two in length, thick and fleshy, with numerous yellow 
rootlets, and is found usually in the shops in slices or fragments, 
externally of a blackish color and internally of a dingy-white color. 
It is inodorous, but has a bitter, acrid taste, which leaves a per- 
manent impression on the mouth and fauces. For use, attached 
portions of the dried stem should be rejected, as they are inert. 

Chemical Constituents. — C. L. Mitchell's* analysis of the 
rhizome shows it to contain veratroidine and jervine (the latter found 
also in V. album), rubijervine, pseudojervine, with resin and oily 



* Proceedings Am. Pharm. Associat., 1874, p. 397- 

According to Wright and Luff* the alkaloids of veratrum viride are essentially jervine, 
fseudojervine, cevadine, with a trace of veratrine and veratalbine, cevadilline being absent; 
of veratrum album, fseudojervine, jervine, veratalbine, rubijervine and veratrine (a trace). 

* Journal of Chemical Society, Vol. I, 1879, P- 4°5- 

16 



242 MATERIA MEDICA AND THERAPEUTICS. 

matter. Some authorities state that it contains also veratrine 
(Wormley), but this is still an open question. Veratroidine is a 
white, uncrystallizable powder, of a bitter taste, leaving a tingling 
sensation in the fauces, soluble in alcohol, ether and chloroform. 
Jervine is a white, tasteless powder, which crystallizes from an 
alcoholic solution, insoluble in water and ether, and freely soluble in 
alcohol and chloroform. 

Aids. — Upon the heart, aconite ; its emetic action is favored 
by ipecacuanha. 

Contraindications. — The preparations of veratrum viride 
should only be given to strong, robust patients, and rarely made 
use of in any asthenic malady, or in cardiac valvular disease. 

Physiological Effects. — Veratroidine is an emetic , and some- 
times a cathartic, and a depressant to the circulation. Nervous sys- 
tem : in animals poisoned by veratroidine, twitching and finally 
convulsions are produced ; the reflex spinal centres are at first de- 
pressed, afterward paralyzed. Circulation : applied directly to the 
heart, it paralyzes the cardiac muscle. , When given hypodermically * 
to animals, it at first lessens the rapidity of the pulse and lowers the 
arterial pressure (due to stimulation of the inhibitory nerves); soon, 
however, the heart's beat becomes greatly increased in force, 
but not in frequency, and the blood-pressure falls to normal ; then 
suddenly the pulse becomes very rapid, and the cardiac force is les- 
sened (due to peripheral paralysis of the inhibitory nerves), and the 
tension rises much above the normal (caused by increasing asphyxia). 
Respiration : in animals poisoned by veratroidine, death is caused 
by asphyxia, due to paralysis of the respiratory muscles. Muscular 
system : there is great muscular weakness in poisoned animals. 
Gastro-intestinal tract : veratroidine is an irritant, causing violent 
vomiting and purging in poisoned animals. 

Jervine produces general weakness (without, however, vomit- 
ing or purging), lowering of arterial pressure and slowness of the 
pulse, profuse salivation, and finally convulsions. Locally, jervine 
is a feeble irritant. Nervous system : the effects of jervine are 
similar to those of veratroidine, but, in addition, the vaso-motor 
nerves are paralyzed. Circulation : f when applied directly to the 
heart of the frog, it paralyzes it. When a warm-blooded animal 
is poisoned with jervine, the frequency of the pulse is diminished, 

*Pkila. Med. Times, Vol. IV. H. C. Wood. ^ Ibid. 



SEDA TIVES— VERA TR UM VIRIDE. 



243 



and the arterial pressure falls greatly, due to the direct action 
of the drug on the cardiac muscle, as well as to paralysis of 



Fig. 20. 




VERATRUM VIRIDE. 



244 MATERIA MEDICA AND THERAPEUTICS. 

the vaso-motor centres. Respiration : death takes place from 
asphyxia. 

The alkaloids exist, in both V. viride and album, in but small 
proportions, and can scarcely be profitably extracted. 

The effects of veratrum viride are similar to those of its two 
alkaloids described above. It is an active local irritant. Taken 
internally, it somewhat promotes the flow of urine, and in doses of 
about five grains proves emetic. In continued doses it produces a 
marked sedative action on the circulation, irrespective of the nausea 
induced, which, indeed, may be prevented by careful administration, 
and the temperature of the body is much lowered. It has not 
generally proved laxative. 

Toxicology. — A few fatal cases are recorded from its use — 
though stimulants almost invariably counteract any excessive seda- 
tion. Recovery has taken place after fgj of the tincture had been 
swallowed, while f5j of the tincture has destroyed life, * and in 
another case f about Ttlxxx proved fatal. 

Medicinal Uses. — Veratrum viride is used principally as a 
cardiac and vaso-motor depressant. In pneumonia, in which the 
danger is chiefly from failure of cardiac power, the use of veratrum 
requires caution and is serviceable only in the early stage, before 
exudation has taken place. It is also useful in cardiac affections, as 
over-action of the heart, or hypertrophy unaccompanied by valvular 
disease, and to moderate vascular excitement. In active hemorrhage 
and in acute congestions generally it is also of value as a sedative. 
It has been recommended in puerperal eclampsia,\ on account of 
its depressing influence on the reflex centres of the cord (Fordyce 
Barker, Boyd, N. L. Guice, etc.) ; it should be given in doses suffi- 
ciently large to reduce the pulse to 60 or 80 beats per minute and this 
effect should be maintained. A few drops of the tincture repeated 
every hour or two, according to the condition of the pulse, will 
abort an ordinary " cold in the head," if given early enough). 
Dose, of the powder, gr. j-ij to begin with; of the tincture, gtt. v-x; 
of the fluid extract, gtt. iv-v. 

Veratrina {Veratrine) (C 3 . 2 H 52 N 2 8 ) is an alkaloid or mixture of 
alkaloids obtained from the seeds of Asagraea officinalis (Nat. Ord. 
Melanthaceae), an herbaceous plant of Mexico, which contains no 

* Med. Times, Aug., 1884, p. 863. 

■j- Med. and Surg. Reporter, May, 1873, P- 379« 

% Canacian Practilio?ier, March, 1885, p. 366. 



SEDATIVES— VERATRUM VI RIDE. 245 

jervia. * It is made by evaporating a strong tincture of the seeds 
to the consistence of an extract, from which the alkaloid is dis- 
solved by diluted sulphuric acid, and afterward precipitated by 
magnesia. When pure it is white, but it is usually a grayish or 
brownish-white powder, without odor, but very irritant to the nos- 
trils, and of a bitter, acrid taste, producing a sense of tingling or 
numbness in the tongue ; scarcely soluble in cold water, but readily 
soluble in alcohol, and of an alkaline reaction. A delicate test for 
veratrine is Trapp's — a permanent lilac-red color, resembling a 
solution of potassium permanganate, afforded by boiling it in hydro- 
chloric acid. 

Physiological Effects. — Locally ■, veratrine acts as an irritant, f 
producing heat, pain, and numbness in the part to which it is 
applied. Nervous system : its action on the brain is not marked, 
and the reflex excitability of the spinal cord is diminished in 
animals after the administration of a large dose (Ott). Veratrine 
acts as a direct poison upon nerves (Ott, Wood, H. C, etc.), but 
whether it affects the nerve-trunk or its end-organs is still subjudice. 
Circulation and blood : in animals, small doses stimulate the excito- 
motor cardiac ganglia and increase the frequency of the cardiac 
beats; large doses stimulate the pneumogastric nerve, and as the 
excito-motor ganglia become exhausted, the cardiac beat is slowed. 
It also poisons the cardiac muscle. It probably paralyzes the cen- 
tral vaso-motor % apparatus eventually. The blood-pressure is, at 
first, elevated, then lowered, and the blood is rendered less coagu- 
lable. Respiration and temperature : small doses increase, while 
larger doses diminish, the frequency of the respiratory movements, 
and the temperature is lowered. It destroys life by paralysis § of 
respiration. Excretion : the excretions from the skin and kidneys 
are increased. Gastro-intestinal tract : in large doses it is an irri- 
tant poison, causing severe vomiting and purging. || Muscular sys- 
tem : \ muscular irritability is at first exalted (producing convul- 
sions), but is afterward entirely lost. Heat** increases and cold 



* Proceed. Am. Pharm. Associat., 1874, P- 397- C. L. Mitchell. 
f Bull. Gen. de Therap., CV, 430. Sur Taction physiologique de la veratrine. 
\ Arch, fur Exper. Pathol, u. Pharmakol., 1887, P- 36. Untersuchungen liber die 
Wirk. der Veratrumalkaloide, von H. Lissauer. $ Ibid. 

|| Bull. Gen. de Therap., CV, 430. Sur Taction physiologique de la veratrine. 
If Journal de V Anatomie et de la Physiologie, 1868, p. 206. 
*» The Journal of Physiology, Vol. IV, p. 1. 



246 MATERIA MEDICA AND THERAPEUTICS. 

lessens the effects of veratrine on muscle. Its toxic action is 
comparable to that of its congeners. Elimination : by the kidneys. 

Stimulants and ethereal inhalation would be the proper treat- 
ment in cases of poisoning. 

Medicinal Uses. — Veratrine is rarely prescribed internally ; the 
dose is gr. tV toe repeated; it is chiefly used externally, in the form 
of ointment (4 parts, to alcohol 6 parts, and benzoinated lard 96 
parts) ; or dissolved in alcohol, as an application to rheumatic and 
neuralgic affections. Oleatum veratrince (veratrine oleate) consists 
of veratrine 2 parts, to 98 parts of oleic acid : useful in spinal irri- 
tation, rubbed over the vertebrae. 

PULSATILLA— PASQUE-FLOWER. 

The herb of Anemone pulsatilla, Anemone pratensis and 
Anemone patens (Nat. Ord. Ranunculaceae), is found in both hemi- 
spheres. It should be collected soon after flowering and carefully 
preserved, but should not be kept more than a year. It contains 
an acrid volatile oily substance, easily converted into anemonin, 
C 15 H ]2 6 , and anemonic acid, C 15 H H 7 (Maisch). 

Incompatibles. — The caustic alkalies, tannic acid, and metallic 
salts. 

Aids. — Aconite enhances its action upon the heart, respiration 
and temperature. 

Physiological Effects. — Locally, fresh pulsatilla is an irri- 
tant, and after prolonged contact with the skin may cause inflam- 
mation, or even gangrene. When the powder is inhaled, it pro- 
duces itching of the eyes, colic, vomiting, diarrhoea, etc. (Phillips). 
Nervous system : motor and sensory paralyses are produced 
in animals by large doses, but in what way has not yet been 
ascertained. After poisonous doses, dilatation of the pupil, sopor, 
coma, and convulsions occur. Circulation: pulsatilla is a cardiac 
depressant, and lowers the arterial pressure. Respiration and tem- 
perature: it slows the respiration (Clarus), and reduces the tempera- 
ture. Gastro -intestinal tract: it is an irritant poison, in large doses 
producing vomiting and purging. Elimination: probably takes 
place through the kidneys. 

Medicinal Uses. — Pulsatilla, owing to its irritant action on 
the digestive tract, is not well borne, and, moreover, possesses no 
superiority over more efficient sedatives like aconite. 

The powdered herb may be given in doses of gr. ij-v, or an 
extract or tincture may be made. 



SEDA TIVES—PHYTOLA CCA. 247 



ARNICA. 

Arnicse Flores, Arnica Flowers ; Arnicas Radix, Arnica Root. 

Arnica montana, Leopard's Bane {Nat. Ord. Compositae), is a 
perennial herbaceous plant, found in northern Germany and other 
northern countries of Europe, and also in the northwestern portions 
of America. The flower-heads and the rhizome and kootlets 
are the official portions. Both contain volatile oil, arnicin, resins, 
etc. ; the root contains, in addition, inidin and tannin. 

Effects and Uses. — Locally, arnica is a stimulant and often an 
irritant to the skin. The internal effects of this drug are not well 
understood. Large doses cause headache and dilatation of the 
pupils; poisonous doses paralyze the nervous system, and death 
ensues from collapse. Moderate doses lower (in dogs) the pulse by 
stimulating the pneumogastrics peripherally and centrally, raise 
slightly the arterial pressure, and depress the respiration and tem- 
perature. (H. A. Hare.*) Small doses are said to excite the 
action of the skin and kidneys. In large amounts it is an irritant 
to the gastro- intestinal tract, producing nausea, vomiting and purg- 
ing of a choleraic character, and also great muscular weakness. 

In this country it is principally used externally, in the form of 
fomentation or lotion, for the relief of bruises, wounds, sprains and 
local paralysis. The fluid extract 'of 'the root [alcoholic) is given in doses 
of gr. v-x. This is chiefly used, however, in making a plaster (em- 
plastrum arnica?). The fluid extract of the root is given in doses 
of TTlx-xx. The tincture of the root and the tincture of the flozvers 
may be given in doses of TTLv-xxx. They are often used extern- 
ally combined with soap-liniment. In applying arnica externally, 
the irritating qualities of the drug should be borne in mind. 

PHYTOLACCA. 

Phytolacca^ Bacca, Phytolacca Berry ; Phytolacca? Radix, Phytolacca Root. 

Phytolacca is the fruit and root of the Phytolacca decandra 
(Nat. Ord. Phytolaccaceae), commonly known as Poke-Berries and 
Poke-Root. It is a perennial herb, indigenous to North America, 
growing to the height of four to eight feet, and found in waste 
places. The young stems, collected in the spring and boiled, are 
sometimes eaten at table. The root contains resin, starch, tannin, 

* Boston Med. and Surg. Journ., Jan. 12th, 1888. 



248 MATERIA MEDICA AND THERAPEUTICS. 

etc.; the berries contain sugar, gum, coloring matter, etc. An indif- 
ferent crystalline principle termed phytolaccin has been isolated, by 
Claassen.* Partee, f in a recent analysis of the root, could detect 
no alkaloid. 

Effects and Uses. — Phytolacca paralyzes the motor-centres of 
the cord and medulla. In overdoses it causes dimness of vision, 
coma and sometimes convulsions (Stille and Maisch), and death is 
produced by paralysis of the respiratory centre. Phytolacca de- 
presses the cardiac action and respiration, and produces nausea and 
vomiting, which does not take place until about an hour after the 
drug is administered, and which is accompanied by great depres- 
sion. Purging also takes place, and Rutherford found it to be a 
powerful hepatic stimulant, increasing the secretion of bile. It is 
eliminated by the kidneys. 

Phytolacca has been used with success as an alterative in the 
treatment of rheumatism cf syphilitic origin (Stille and Maisch). It 
is useful in phlegmons % of the breast, to allay the inflammation and 
prevent suppuration, and possibly may exert a like influence on 
other inflamed glands, as adenitis. 

It is recommended as a local application to leg ulcers (Tidd §) 
and eczema, and also in scabies and tinea capitis. || As it produces 
great depression it should not be used as an emetic. Dose of the 
powder, gr. j-xxx ; or a tincture (Sjv-Oj), or fluid extract may be 
used, dose Hlv-f 5j. For local use, an ointment may be prepared 
(5~oj). These preparations are not official. 

STAPHISAGRIA. 

Staphisagria, Stavesacre, or Licebane, is the seed of the Del- 
phinium Staphisagria, (Nat. Ord. Ranunculaceae), a beautiful bien- 
nial plant, with terminal racemes of blue flowers, native of south- 
ern Europe. It contains three alkaloids, delphinine (C 24 H 35 NO 20 ), 
delphinoidine , delphisine, and staphisain ( C 16 H 23 N0 2 ) ; also fixed 
oil, etc. 

Physiological Effects. — When applied to the skin delphinine 
acts as a rubefacient and irritant. When administered internally to 



* The Pharmacist and Chemist, 1879, P- 4^6- 

f Am. Journ. of Pharmacy, March, 1888, p. 123. 

\ Am. Jour. Med. Sci., 1873, P- 2 75- 

§ The Clinic, Vol. V, p. 273. 

|j J. Bigelow, quoted in Piffard's " Mat. Med. and Therap. of the Skin. 



SEDA riVES— ANTIMONY. 249 

animals in lethal amounts it produces convulsions, muscular inco- 
ordination, and finally clonic spasm ; the reflex centres of the cord 
are palsied (Cayrade,* and cutaneous anaesthesia is produced (Falck 
and Rorig t), and finally the respiratory centre is paralyzed, causing 
death from asphyxia. The effects on the circulation are most 
marked. It slows the cardiac action and paralyzes the heart by a 
direct action on its muscle and nervous supply (Flack and Rorig, % 
L. Van Praag). It causes dyspnoea, slows the respiratory move- 
ments and paralyzes the voluntary muscles. It provokes salivation 
and induces vomiting (an early symptom), due to irritation of the 
end-organs of the pneumogastric nerves. It acts upon the digestive 
system no matter how introduced. It is eliminated chiefly by the 
biliary and salivary secretions and kidneys, producing constipation 
and difficult urination during excretion. It destroys life by as- 
phyxia. The treatment of poisoning by staphisagria should be by 
artificial respiration, strychnia and atropia. 

Medicinal Uses. — It is chiefly used as a local parasiticide in 
pediculi and scabies, although an ointment is applied in phthiriasis. 
Dose of the powder, gr. j-iij ; or a tincture ( I part to alcohol 5 
parts — dose TTLx-xv), or fluid extract may be used. An ointment 
(digest 5ij of bruised seed in lard oj and strain while hot) is the 
best form for external use. None of these preparations are official. 

ANTIMONII PR.EPARAT A— PREPARATIONS OF ANTIMONY. 

Antimonii Oxidum (Antimonious Oxide) (Sb 2 3 ) is a heavy gray- 
ish-white, insoluble powder, having the general therapeutic proper- 
ties of the antimonials, and though not quite certain in its effects — 
as its solubility depends on the amount of hydrochloric acid which 
may exist in the stomach — it is believed to produce the sedative 
operation of tartar emetic, with less nausea and derangement of the 
stomach. Dose. gr. ij-iij, repeated. 

Antimonii et Potassii Tartras (Antimonium and Potassium Tar- 
trate). This salt, familiarly known as tartar emetic and tartarized 
antimony, is prepared by boiling water and cream of tartar with 
antimonious oxide. It occurs in colorless, transparent, rhombic, 



* Journ. de VAnat. et de Physiol. Mai et Juin, 1869. 317. 

f Archiv.fur. phys., Heilkun., 525-548, 1852, and Kong's Dissert, de Effectu Delphini, 
Marburg, 1852. 

% Virch. Arch., Bd. VI., 385-448, und 435-457. See also Researches on Staphisagria in 
Bull. Gen. de Therap., i89i,by Gautier, p. 185. 



250 MATERIA MEDICA AND THERAPEUTICS. 

octahedral crystals, which become white and opaque from efflo- 
rescence on exposure to the air. When pure its powder is perfectly 
white ; but it is to be preferred in the crystalline state, as in this 
form it is less liable to adulteration. In testing for antimony the 
metal itself should be reduced, as by Marsh's test (see Arsenious 
Acid). The powder of tartar emetic is sometimes adulterated with 
cream of tartar, which may be detected by adding a few drops of a 
solution of sodium carbonate to a boiling solution of the anti- 
monium salt, and if the precipitate formed be not re-dissolved, no 
potassium bitartrate is present. 

Tartar emetic (2KSbQH 4 7 .H 2 0) is inodorous ; has a nauseous, 
metallic taste; is soluble in 15 parts of cold and 3 parts of boiling 
water; insoluble in pure alcohol. 

Incompatibles of Tartar Emetic. — It is decomposed by the 
alkalies and the alkaline carbonates ; the vegetable astringents con- 
taining tannic acid form an insoluble tannate with it. 

Aids. — Aconite, veratrum viride, etc., enhance its sedative 
powers ; ipecacuanha promotes its emetic effect ; paregoric, sweet 
spirit of nitre and ipecacuanha (small doses), its diaphoretic action. 

Physiological Effects. — Tartar emetic is a powerful local irri- 
tant. Applied to the skin, it occasions an eruption of pustules, 
resembling those of variola or ecthyma. When taken into the 
stomach, in full doses, it causes vomiting, purging, griping pains, 
etc. The constitutional effects of tartar emetic, when taken intern- 
ally in small doses, are an increase in the secretions and exhalations 
generally, especially from the skin ; the quantity of carbonic acid 
exhaled by the lungs is increased ; the amount of urine excreted 
is lessened, but the urea is much augmented (Ott); after large doses 
albuminuria is often seen ; in somewhat larger doses, these effects 
are accompanied with nausea and vomiting, relaxation of the tis- 
sues (particularly the muscular fibres), a feeling of great feebleness 
and exhaustion, and at first a stimulant, later a powerful sedative, 
action on the circulation and respiration, the cardiac action becom- 
ing slow, weak and finally irregular, and the arterial tension low- 
ered. It acts on the heart by depressing the excito-motor nerves 
and paralyzing the cardiac muscle. After poisonous doses the red 
blood-corpuscles are altered in form, and together with the albu- 
men, are diminished in amount, in the blood of animals; the fibrin 
is increased (Ott). The temperature of the body is lowered. In 
small, repeated doses, continued for some time, it produces fatty 



SEDA TIVES— ANTIMONY. 251 

degeneration of the liver. It is eliminated slowly by the bile, milk, 
perspiration and urine, also by the bronchial mucus and the intesti- 
nal secretions. 

Toxicology. — In excessive quantity, it acts as an irritant poi- 
son, and has produced death with great prostration, syncope, 
and diminution of reflex irritability. The minimum fatal dose 
for an adult is gr. ij ; for a child, gr. ^ (Taylor). On the other 
hand, very large quantities have been taken without fatal re- 
sults. 

Antidotes. — Fortunately the ingestion of toxic amounts of 
tartar emetic is quickly followed by vomiting. But if the poison 
has not been entirely rejected, or if emesis has not occurred at all, 
tannic acid, the chemical antidote, should be administered (strong 
infusion of tea, cinchona or oak-bark) which forms an insoluble 
tannate, and consequently the absorption and irritative action of the 
poison ' is impeded. After this the stomach-pump must be used. 
Should there be evidence of much gastric irritation the exhibition 
of demulcents will be in order. 

Medicinal Uses. — Tartar emetic is employed internally as an 
emetic, sedative, sudorific and expectorant, and locally as a counterirri- 
tant. It is to be used with great caution on account of the prostration 
which it produces, and should never be given to young children, 
nor when gastro-enteric inflammation is present. It should only 
be used in sthenic cases in robust adults. As an emetic, it creates 
more nausea and depression than any other substance ; and hence, 
while other emetics are to be preferred to it, when our object is 
merely to evacuate the contents of the stomach with as little con- 
stitutional disturbance as possible, it is of value when vomiting is 
to be resorted to as a means of making an impression on the system 
in the hope of checking the progress of disease. As a sedative anti- 
phlogistic, in large doses it is a most powerful remedy in the treat- 
ment of acute inflammation, with fever, from its combined action in 
reducing the force and frequency of the circidation, moderating the 
heat of the skin, and promoting diaphoresis. When given in this 
way, at intervals, tartar emetic ceases to produce emesis, owing to 
the establishment of tolerance of the medicine. It is inferior to 
other sedatives, as aconite, etc. In the early stages of acute laryn- 
gitis and bronchitis, it is a remedy of great value. From gr. T V? may 
be given every two hours in gradually increasing doses, until some 
amelioration of the symptoms takes place, when the doses are to 



252 MATERIA MEDICA AND THERAPEUTICS. 

be again decreased; a favorite combination with many physicians 
is: 1^ Antimonii et potassii tartratis, morphinae sulphatis, aa gr. j ; 
aquae, f^ij. M. One teaspoonful contains gr. T \ each of tartar 
emetic and morphine. As a diaphoretic, it is very useful in small 
doses (as from T Vi> repeated), in continued fevers, inflammation 
from wounds, injuries, etc.; and as an expectorant, when there is 
fever, a full pulse, and but little expectoration, as in acute bronchitis, 
in the same doses; it is also employed in various pulmonary affec- 
tions with advantage. As a local irritant, it is rarely used, and is 
in many cases injurious. 

Administration. — The dose of tartar emetic, as an emetic, is 
gr. j-ij, and it is frequently combined with ipecac. As a sedative 
antiphlogistic, gr. %-% to gr. j-ij. As a diaphoretic and expectorant, 
gr. ^- l , may be given in solution, and in each case repeated every 
two or three hours. It is advantageously combined with small 
doses of morphine, when decided diaphoresis is aimed at. 

Vinum Antimonii [Antimonial Wine) is a solution of tartar 
emetic (4 parts) in boiling distilled water (60 parts) and stronger 
white wine (to make 1000 parts). It is employed as an expectorant 
and sudorific, in bronchitis, etc., in the dose of from gtt. x-xxx, fre- 
quently repeated ; and as an emetic for children, in the dose of gtt. 
xxx to f5j, repeated every quarter of an hour. Other emetics are 
to be preferred. 

Antimonii Sulphidum [Antimonious Sulphide), the native sul- 
phide, purified by fusion, and Antimonii Sulphidum Purification 
{Purified Antimonious Sulphide), are used in making the other 
preparations. 

Antimonium Sulphuratum (Sulphurated Antimony) is a reddish- 
brown, odorless, almost tasteless, insoluble powder, and is chemi- 
cally a mixture of antimonious sulphide (Sb 2 S 3 ) and oxide (Sb 2 3 ). 
Its effects are analogous to those of tartar emetic. Dose, gr. j-iij ; 
as an emetic, gr. v-xx. 

Pilulee Antimonii Compositae [Compound Pills of Antimony), 
sometimes called Plummets Pills. They are used as an alterative 
in rheumatic and cutaneous affections. One pill contains of calo- 
mel and sulphurated antimony each gr. ss. 

Pulvis antimonialis. An antimonial powder is prepared in 
imitation of the celebrated James's powder, by mixing antimonious 
oxide (33 parts) with precipitated calcium phosphate (67 parts). 
It is a white, gritty, tasteless, odorless powder. Dose, gr. iij-viij. 



SEDA 1 7 / ES - PO TASSIUM NITRA TE. 253 



POTASSII NITRAS— POTASSIUM NITRATE. 

This salt, commonly called nitre and saltpetre (KN0 3 ), occurs 
in both the inorganic and organic kingdoms of nature. It is 
obtained, for medicinal use, principally by the purification of the 
native nitre of India ; and it is found also in saltpetre caves in 
various parts of the United States, associated with calcium nitrate, 
from which it is separated by lixiviation. It is artificially pro- 
duced in several parts of Europe, in nitre beds or saltpetre planta- 
tions, by bringing together decayed organic animal and vegetable 
matters. And it is manufactured sometimes by the double decom- 
position of sodium nitrate and potassium chloride. Nitre is refined 
by re-solution and crystallization of the crude nitre. As purified 
for medicinal use, it is found in the shops in large, transparent, 
colorless crystals, of the form of six-sided striated prisms, with 
dihedral summits, which are unalterable in the air. They have no 
odor, a sharp, cooling taste, are wholly soluble in water, and insol- 
uble in pure alcohol. They are without water of crystallization, 
but frequently have a portion of the mother liquid mechanically 
lodged in the spaces of the crystals, which may be driven off by 
heat, and the salt fused and cast into moulds, when it is termed sal 
prunelle. 

Physiological Effects of the Potassium Preparations. — 
As the effects of the potassium salts are largely due to their base, 
it will be more convenient to consider them together, pointing out 
any differences when the various preparations are considered. 
Locally \ some of this group, as potassa fusa, abstract water from the 
tissues, dissolve albumen and saponify fats, and hence are caustics. 
The nitrate is a violent irritant when applied to mucous membranes 
or raw surfaces. Nervous system : in large doses, they may pro- 
duce coma, and they act on the spinal centres, by lowering reflex 
excitability and causing paralysis of the lower extremities when 
given in large amounts. Circulation : all the potassium salts are 
cardiac poisons, their activity being due to the potassium, and 
varying with the amount of the base they contain. In moderate 
doses they slow the heart and increase the arterial pressure, while 
in large doses they both diminish the frequency of the cardiac pul- 
sations and lower the blood-pressure. Animals poisoned by them 
die from cardiac paralysis (the heart being arrested in diastole), 
caused by direct action on the cardiac muscle and also by paralysis 



254 MATERIA MEDICA AND THERAPEUTICS. 

of the cardiac ganglia. Blood : after large doses, or when taken 
for some time, the blood is found to be less coagulable (the fibrin 
being diminished), the white corpuscles relatively increased, and 
the venous blood lighter in color (Phillips). After large doses of 
the nitrate or chlorate, the blood becomes dark and refuses to take 
up oxygen, and the hemoglobin is decomposed. The compounds 
with the vegetable acids increase the alkalinity of the blood. Tem- 
perature is reduced by large doses, especially when the nitrate or 
chlorate has been given. Secretion : the alkaline potassium com- 
pounds, like alkalies in general, when applied to the orifices of 
glands with acid secretions, increase, but when applied to glands 
with alkaline secretions, diminish their secreting power (Ringer). 
This does not apply to the nitrate. They increase the water of the 
urine and the urea, and lessen the amount of uric acid. If the bi- 
carbonate is given during fasting, the acidity of the urine will be 
increased, but the urine will be alkaline if it is administered during 
digestion. The alkalinity of the urine is most marked after the inges- 
tion of the salts with the vegetable acids (as the tartrate, citrate, etc.). 
The nitrate and chlorate do not affect the reaction of the urine. 

Gastro-intestinal tract : when the alkalies are given on an 
empty stomach, the secretion of the acid gastric juice is increased; 
if given when gastric digestion is in progress, they neutralize the 
acidity of the secretion. In large amounts, potassa or the chlorate, 
nitrate, carbonate or chloride excites violent inflammation, causing 
vomiting, purging, etc. Nutrition : the alkalies in small doses im- 
prove digestion, aid in saponifying fats, and promote oxidation of 
tissue, but when administered for too long a time, especially if 
given in large doses, they cause emaciation and pervert nutrition. 
Elimination : the potassium salts are eliminated chiefly by the urine, 
but to some extent also by the other secretions. The salts with the 
vegetable acids, during their passage through the system, are con- 
verted into carbonates and are eliminated under this form. Potas- 
sium nitrate and chlorate are discharged unchanged in the urine 
and as sulphates in the feces. 

Toxicology. — In excessive doses, nitre may act as a fatal poison, 
producing irritation of the alimentary canal and derangement of the 
nervous system; the symptoms are burning pain in the throat and 
stomach, bloody stools, a tendency to syncope, collapse, and death, 
sometimes preceded by dilated pupils, insensibility and convul- 
sions. There is no antidote for it, and cases of poisoning are to be 



SEDATIVES— POTASSIUM CITRATE. 255 

treated by demulcents, opiates, stimulants, etc., after evacuation 
of the contents of the stomach. 

Medicinal Uses. — Nitre is not as much used as it was 
formerly. It may be given as a refrigerant and sedative in 
fevers , inflammations, hemorrhages, etc. In fevers it is sometimes 
prescribed with calomel and tartar emetic, under the name of 
nitrous powders (nitre, gr. x ; tartar emetic, gr. y% ; calomel, gr. J^ to 
y£). In large doses it was given formerly in acute rheumatism, and 
this practice has been revived with success in France. It is some- 
times combined with Dover's powder (of each gr. iij-v or viij) in 
the treatment of acute muscular rheumatism. Dose, gr. x-xxx. 
From Jiv-vj are given in twenty-four hours, in acute rheumatism, 
and the quantity is increased to 3viij-x, or xij. Charta Potassii 
Nitratis [Potassium Nitrate Paper) consists of strips of white un- 
sized paper immersed in solution of potassium nitrate (20 parts to 
80 parts of distilled water). The inhalation of the fumes arising 
from the burning of these papers is used with advantage in spas- 
modic asthma. 

Sodii Nitras [Sodium Nitrate, NaN0 3 ). This salt, commonly 
called cubic nitre, is found in large deposits in South America, 
chiefly in Peru, but also in Bolivia and Chili. The crude salt occurs 
in rather soft and pliable lumps, of white, yellow or gray color; it 
is often purified in Peru by solution, crystallization and desiccation, 
but it is usually refined after importation. It occurs in colorless 
rhombohedral crystals, slightly deliquescent, and wholly soluble in 
water, without odor, and of a sharp, cooling and bitter taste. 

Effects and Uses. — Sodium nitrate has been little used in 
medicine, its employment having been limited chiefly to acute dys- 
entery, in which it is highly praised by German physicians, in 
amounts of from Sss-j, in mucilaginous solution, during the day. 
Its effects are analogous to those of potassium nitre. The sodium 
salts are not as powerful cardiac poisons, neither do they affect the 
temperature nor act on the nervous system to the same extent. 
They impede coagulation, but do not alter the blood-corpuscles. 

REFRIGERANTS. 
POTASSII CITRAS— POTASSIUM CITRATE. 

This salt (formerly known as Salt of Riverius) is made by satu- 
rating a solution of citric acid with potassium bicarbonate, and 
evaporating to dryness. It is white, granular, inodorous, of a saline, 



256 MATERIA MEDIC A AND THERAPEUTICS. 

slightly bitterish, but not unpleasant taste, deliquescent, and wholly 
soluble in water (K 3 C 6 H 5 7 .H 2 0). It is an excellent refrigerant 
diaphoretic, much employed in febrile affections. Dose, gr. xx-xxv; 
5vj are usually dissolved in water Oss, and fSss of the solution is 
administered every hour or two. The salts of the alkalies with 
vegetable acids, as citrates, tartrates and acetates, during their passage 
through the body are converted into carbonates. To neutralize the 
urine in renal calculi, due to uric acid, 5^-j should be taken every 
three hours for two or three months. 

Liquor Potassii Citratis {Solution of Potassium Citrate) may be 
made by dissolving separately citric acid 6 parts and potassium bi- 
carbonate 8 parts in water enough to make the combined solu- 
tions weigh ioo parts; dose, f§ss. 

Mistura Potassii Citratis [Mixture of. Potassium Citrate, or Neu- 
tral Mixture) is made by saturating fresh lemon-juice with potass- 
ium bicarbonate; or, when the lemon-juice cannot be had, a solution 
of citric acid, flavored with oil of lemon, may be used as a substitute. 
This preparation contains some free carbonic acid, which renders it 
more grateful to an irritable stomach than the ordinary solution 
of the citrate. Under the name of effervescing draught the potas- 
sium citrate is often prepared extemporaneously (fresh lemon-juice 
f5ss with an equal measure of water, added to a solution of potas- 
sium carbonate 3u in water f 5iv), and is given in the state of effer- 
vescence; it is an excellent remedy for gastric irritability, with 
fever. 

LIQUOR AMMON1I ACETATIS— SO LUTION OF AMMONIUM ACETATE. 

This solution, termed also Spiritus Mindereri, or Spirit of 
Mindererus, is made by saturating diluted acetic acid with am- 
monium carbonate, and is a solution of ammonium acetate (NH 4 
C 2 H 3 2 ). When pure it is a colorless liquid, with a saline taste ; 
it should always be made freshly when dispensed. The physiolog- 
ical effects of the ammonium salts have already been considered 
{vide index). In small doses it is refrigerant ; in larger doses, 
diaphoretic and diuretic. It is employed in febrile and inflammatoiy 
affections, sometimes in conjunction with nitre or one of the se- 
datives, sometimes combined with camphor and opium. Given in 
full doses, frequently repeated, it is one of the best means of re- 
moving the effects of alcoholism. Dose, f§ss-j every two, three or 
four hours, in sweetened water. 



SEDATIVES—VEGETABLE ACIDS. 257 

SPIRITUS ,ETHERIS NITROSI-SPIRIT OF NITROUS ETHER. 

This preparation, commonly known as Sweet Spirit of Nitre, is 
a solution of ethyl nitrite (C 2 H 3 N0 2 ) in alcohol. Spirit of nitrous 
ether is a volatile, inflammable liquid, of a pale-yellow color, in- 
clining slightly to green, has a fragrant, ethereal odor, free from 
pungency, and a sharp, burning taste, and mixes with water and 
alcohol in all proportions; sp. gr. 0.823 to 0.825. It contains five 
per cent, of nitrous ether. It should not be long kept, as it be- 
comes strongly acid by age. 

Incompatibles. — Mucilage of acacia, antipyrine, and it liberates 
iodine in solutions of the iodides. 

Toxicology. — The inhalation of sweet spirit of nitre has pro- 
duced dangerous and even fatal effects : pallor of the face, livid dis- 
coloration of the lips and fingers, weakness of the pulse, muscular 
prostration, praecordial oppression, and headache are the symptoms 
described. The same symptoms may be produced by excessive 
doses. A case is recorded in which death was attributed to the in- 
halation of the ether from a broken bottle in a sleeping apartment. 

Effects and Uses. — Sweet spirit of nitre is antispasmodic, 
refrigerant, diaphoretic, and diuretic. As a diaphoretic, small doses 
should be given, largely diluted and frequently repeated. It is 
much used in febrile affections, and, from its diuretic properties, is 
often combined with other diuretics in the treatment of dropsies. 
From its pleasant taste and smell it is very acceptable to children. 
Dose, f 3ss-j, frequently repeated. 

ACIDA VEGETABILIA— VEGETABLE ACIDS. 

The vegetable acids are refrigerant, and, when properly diluted, 
form useful drinks in fevers, etc. Those chiefly employed are 
acidnm aceticum [acetic acid), acidum citricum [citric acid), and 
acidnm tartaricum [tartaric acid). 

Incompatibles. — The alkaline hydrates, carbonates, and acid 
carbonates. The vegetable acids unite to form salts with the alka- 
line, earthy and metallic bases ; the acetates of these are all soluble. 
Acetic acid forms red ferric acetate with tincture of ferric chloride. 

Toxicology. — There are no recorded cases of poisoning with 
citric acid; tartaric 5^ is alleged to have caused death in one 
instance ; fatal results from acetic are rare.* The antidotes are the 
alkalies. 



* Medical Press and Circular, Nov. 17th, 1880, p. 417. 
17 



258 MATERIA MEDICA AND THERAPEUTICS. 

Effects and Uses. — The following description is based on the 
investigations of H. Bence Jones * and F. Walter, f Applied to a 
raw surface or (if sufficiently concentrated) to the mucous membranes, 
they act as irritants. Acetic acid is the most powerful, and will, 
when applied to the skin, cause blanching, from contraction of the 
capillaries. Citric acid is the least irritant. After large doses the 
cardiac beat is slowed and weakened, but this is possibly due to the 
resulting gastro-enteritis. According to Walter they do not neu- 
tralize the alkalinity of the blood. It is unknown under what con- 
ditions they exist in this fluid. The general law regarding the 
action of acids on secretion holds good in the case of the vegetable 
acids, viz. : that when applied to the orifices of glands secreting an 
acid fluid they diminish, while when applied to glands secreting an 
alkaline fluid they increase their secreting power. Thus they aug- 
ment the flow of saliva and the intestinal secretion. The ingestion 
of the vegetable acids increases the acidity of the urine. They also 
promote the excretion of both the water and the solids of the urine, 
particularly free uric acid (and may thus lead to calculus). They 
are probably converted into carbonic acid in the system, unite in 
part with bases to form salts, and are eliminated by the kidneys and 
intestinal mucous membrane. Their continued use causes abdom- 
inal pain, flatulence, and diarrhoea. In large doses they produce 
gastro-enteritis, and continued for a lengthy period they induce 
scorbutic symptoms. 

Acetic Acid (HC 2 H 3 2 ) is employed internally only in the form 
of diluted acetic acid (strong acid IJ parts to distilled water 83 
parts). Externally, strong acetic acid (sp. gr. 1.048, and containing 
36 per cent, of monohydrated acid) or glacial acetic acid (nearly 
absolute acetic acid — sp. gr. 1.058) is employed as an escharotic to 
remove warts and in the cure of lupus. Acetic acid is less used in- 
ternally as a refrigerant than citric acid, from its liability to produce 
colic and diarrhoea. Vinegar and water is one of the best injections 
for the cure of gonorrhoea in the female. Spongings with vinegar 
and water are useful to relieve the heat of the skin m fevers, to check 
sweating, as a wash in urticaria, and the vapor is grateful to the sick. 
Concentrated acetic acid is a corrosive poison, for which the alka- 
lies and their carbonates, soap, etc., are the antidotes. Citric Acid 



* Medical Times and Gazette, Oct. 21st, 1854. 

f Arch, fur Exper. Pathol, u. Pharm., 1877, p. 148. 



SPINANTS. 259 

(H 3 C 6 H 5 7 ) may be agreeably administered in the diluted juice of 
lemons, limes, sour oranges, and tamarinds. When these cannot be 
obtained, a solution of citric acid (gr. xx to water Oj) may be sub- 
stituted. Citric acid is manufactured from lemon or lime-juice, by 
saturating it with calcium carbonate and afterward decomposing the 
calcium citrate which is formed, by the addition of sulphuric acid. 
It occurs in colorless crystals, having the form of rhomboidal 
prisms with dihedral summits, freely soluble in water, and soluble 
in alcohol ; oixss, added to distilled water Oj, form a solution of the 
average strength of lemon-juice. In the dose of f5j every hour or 
two, lemon-juice, limo?iis succus (the juice of the fruit of Citrus 
Limonum), has been employed with success in acute rheumatism 
and gout. Of late years, however, it has given place to more reli- 
able modes of treatment. Properly diluted and mixed with sugar, 
it forms the delightful refrigerant known as lemonade. Lemon-juice 
(or, still better, lime-juice) is the most efficient known remedy for 
scurvy, and it is almost infallible as a prophylactic against this 
malady. It has also proved of advantage in jaundice and torpor of 
the liver. Syrup of citric acid consists of citric acid (8 parts) and 
water (8 parts) with oil of lemon (4 parts) and syrup (980 parts). 
Lemon-syrup , which is pleasanter, is made by heating lemon-juice 
(40 parts) to the boiling point, adding lemon-peel (2 parts) and let- 
ting it stand until cool; then filter and add enough water to make 
the filtrate weigh 40 parts ; dissolve sugar (60 parts) in the filtrate 
and strain. Spirit of lemon (sometimes called essence of lemon) is 
made by dissolving oil of lemon 6 parts (obtained from the rind 
of the fruit\ in alcohol 90 parts, and adding freshly-grated lemon- 
peel 4 parts; dose, f5j-ij. Tartaric Acid (H 2 QH 4 6 ) is the acid 
of grapes, and is extracted from tartar or crude cream of tartar. 
It is a white crystallized solid, in the form of irregular six-sided 
prisms, and is found in the shops as a fine white powder, soluble 
in water and alcohol. Being cheaper than citric acid, it may be 
used as a substitute for that acid. It is employed in making 
Seidlitz powders. Tartaric acid in excess yields a precipitate (cream 
of tartar) with a solution of carbonate or other neutral salt of potas- 
sium, while citric acid yields none. 

ORDER VIII. SPINANTS. 

Under the term Spinants, or Spastics, are comprised medicines 
which are employed to excite muscular contraction, or whose ulti- 



260 MATERIA MEDICA AND THERAPEUTICS. 

mate effect is the production of motor-paralysis, and may, accord- 
ingly, be divided into excito-motors and depresso-motors. Of the 
first class, the most important articles are vegetable substances 
containing the alkaloids strychnine and brucine, which are employed 
therapeutically in torpid or paralytic conditions of the muscular 
system; ergot, which is used to excite muscular contraction of the 
uterus ; and digitalis, which is given for its tonic effect on the heart. 
Paramorphine is also an excito-motor agent (see p. 82). The second 
class contains such remedies as conium, physostigma, woorara, etc. 

EXCITO-MOTORS. 
NUX VOMICA. 

Strychnos Nux vomica, or Poison- Nut (Nat. Ord. Logania- 
ceae), is a middling-sized tree of the coast of Coromandel and other 
parts of India, which bears a round, smooth berry, the size of a 
pretty large apple, of a rich orange color, and containing numerous 
seed imbedded in a juicy pulp. The seed are the official portion; 
but the bark also is poisonous, and is known zs false angustura bark, 
from its having been confounded with angustura bark. The seed 
are round, peltate, less than an inch in diameter, nearly flat, or convex 
on one side and concave on the other, and surrounded by a narrow 
annular stria. They have two coats : a simple fibrous outer coat, 
covered with short, silky hairs, of a gray or yellowish color, and a 
very thin inner coat which envelops the nucleus or kernel. This is 
hard, horny, of a whitish or yellowish color, and of very difficult 
pulverization. The seed have no odor, but an intensely bitter taste, 
which is stronger in the kernel than in the investing membrane. 

Chemical Constituents and Tests. — They impart their virtues 
to water, but more readily to diluted alcohol, and contain two 
active alkaloids, strychnine (official) and brucine, both of which exist 
in combination with an acid called igasuric ; another alkaloid, 
termed igasurine, much more soluble in water than the two first 
named, has been lately extracted from nux vomica ; also loganin. 

Strychnina (Strychnine) (C 21 H 22 N 2 2 ) is obtained by the follow- 
ing process : Nux vomica is digested and boiled in water acidulated 
with hydrochloric acid, and the resulting strychnine and brucine 
hydrochlorate is decomposed by milk of lime. The strychnine is 
separated from brucine and impurities by boiling alcohol, from 
which it is deposited when cool, the brucine being left in solution- 
It is then converted into a sulphate by the addition of diluted sul- 



SPINANTS—NUX VOMICA. 261 

phuric acid, next decolorized by purified animal charcoal, and again 
precipitated by solution of ammonia. Thus obtained, it occurs as 
a white or grayish-white powder (but may be made to crystallize in 
the form of white, brilliant rhombic prisms), of an intensely bitter 
taste, almost insoluble in water, slightly soluble in cold alcohol, but 
readily soluble in boiling alcohol. A very delicate test for strych- 
nine is the potassium bichromate : this, added to a solution of 
strychnine in concentrated sulphuric acid, produces a violet color, 
which after a time changes to wine-red, and then to reddish-yellow. 
Lead binoxide, manganese peroxide, potassium ferrocyanide and 
permanganate act in the same way. In these tests the reagent is 
nascent oxygen. The presence of morphine in excess, of certain 
undefined organic substances,* and of curare, may disguise the 

Fig. 2i. 




B 

STRYCHNOS nux vomica, a. b. seeds. 

color-test; here an alkaline mixture of chloroform should be used 
to separate the strychnine from morphine ; while curare can be dis- 
tinguished by its amorphous state. The physiological test should 
be always resorted to : if a small frog be placed in an ounce of water 
cotaining T ^ of a grain of a strychnine salt, in two or three hours it 
will undergo tetanic spasms, and soon die. 

Brucine (C^H^N^^, not official) resembles strychnine in its 
action (Mays f). It differs from it in being locally analgesic and 
often destroying life without a trace of spasm. It the case of an 
adult % gr. ij induced convulsions which were counteracted by 
chloral. The dose is gr. %-%. 



* '' Micro-Chemistry of Poisons," i885, p. 569. 

f Pamphlet, "The Differential Action of Brucine and of Strychnine," Phila., March, 
1887. 

\ Med. and Surg. Reporter, 1882, 194. 



262 MATERIA MEDIC A AND THERAPEUTICS. 

Incompatibles. — Tannic acid, the iodides, chlorides, and bro- 
mides yield precipitates with strychnia; the strychnia bromide 
forms only after standing and can be prevented by dilute HC1. 

Aids. — Electricity, picrotoxin, ergot, ustilago, and ignatia. 

Physiological Effects. — Nux vomica or its alkaloid, strych- 
nine, increases the reflex excitability of the spinal cord, and thus fa- 
vors the production of convulsions. Its action seems to be especially 
directed to excitation of the spinal motor-centres. Klapp * affirms 
that even lethal quantities in the frog have no action on the sensory 
or motor nerve-endings, nor upon their trunks. This statement, how- 
ever, is denied by Vulpian f and others. After death, galvanization of 
the motor-trunks causes little or no contraction in response, due to 
direct action on, and exhaustion of the motor-trunks. It stimulates 
the vaso-motor centres of the brain and spinal cord (Ott), and also 
the respiratory centre. Large doses paralyze these centres at once 
(Klapp), but the vagi are not affected either in warm- or cold-blooded 
animals. Death is due to asphyxia. In very small and repeated 
doses it has a tonic and diuretic effect, and sometimes operates 
slightly on the bowels and skin, but it has no effect on the circulation. 
It is said to be eliminated by the kidneys unaltered. In somewhat 
larger doses, the stomach is often disturbed, the cardiac action is 
accelerated from stimulation of the cardiac ganglia, the visual sense 
is rendered more acute and the retina becomes hyperemic, and in 
still larger doses, the muscular system becomes disordered. A 
sense of weight and weakness in the limbs, and increased sensibility 
to external impressions of all kinds, manifest themselves, with de- 
pression of spirits and anxiety ; the limbs tremble, and slight con- 
vulsive movements of the muscles appear. If the medicine be 
continued, or if a toxic dose be taken, convulsive paroxysms of the 
whole muscular system ensue, with erotic desires, painful sensations 
in the skin, and occasionally eruptions ; the heart is slowed, and 
the blood-pressure increased, probably through vaso-motor spasm. 
In paralytic patients the effects of the medicine are principally ob- 
served in the paralyzed parts. When taken in excessive doses the 
symptoms usually come on suddenly, and within half an hour, and 
consist of paroxysms commencing with a sudden shuddering, 

* The Journ. of Merit, and Nerv. Dis., Oct., 1878, p. 619. *' Physiological Action of 
Strychnine on the Brain, Spinal Cord and Nerves.'' 

"J" Arch, de Physiologie Norm, et Path., ill, 1870, 116. " Remarques touchant Taction 
de la strychnine sur les grenouilles." 



SPINANTS—NUX VOMICA. 263 

quickly passing into a tetanic convulsion of all the voluntary mus- 
cles. The body is bent backward until the occiput and heels sup- 
port its weight (opisthotonus), the corners of the mouth are drawn 
up in a ghastly grin {risus sardonicus), and the face, at.first pale, be- 
comes livid as the paroxysm continues, from interference with 
respiration. Trismus (an early symptom in tetanus) occurs finally 
in severe cases. After a variable time the muscles relax and an in- 
terval of quiet succeeds, during which there is sometimes a slight 
rigidity of the muscles, but no marked stiffness as in tetanus. As 
a rule the paroxysms are painful. 

Toxicology,— If the dose has been sufficient to cause death, 
the paroxysms rapidly succeed one another, increasing progressively 
in seventy and duration until dissolution occurs from fixation of the 
muscles of respiration, the intellect being usually unaffected up to 
the fatal termination. The convulsions resulting from the use of 
strychnine are of spinal origin, and are due to an exaltation of the 
reflex functions together with a stimulation of the motor-cells of the 
cord. The reflex centres are in such an irritable condition that the 
slightest irritation of the surface, as by a breath of air, will produce 
a convulsion. The poisonous dose of strychnia varies widely, as a 
case * is reported (that of Dr. Warner) in which gr. y 2 killed an 
adult in twenty minutes, while recovery followed in a soldier f who 
had taken about gr. xv. 

Antidotes. — There is no chemical antidote, unless, perhaps, 
it be tannic acid, which forms an insoluble tannate. The patient 
is to be kept perfectly quiet and all sources of irritation, as 
draughts or loud noises, should be excluded as likely to cause a 
tetanic paroxysm. The stomach should be emptied and the physi- 
ological antidote, chloral, given. It % acts chiefly by lowering the 
activity of the parts which conduct the excitation to the spinal 
cord, preventing the too frequent repetition of the tetanic spasms 
and lessening their intensity. In grave cases artificial respiration 
should also be resorted to. Some relief is afforded by holding the 
limbs or even by applying friction to them, during the paroxysm. 
The antidotism between strychnine and chloral is not reciprocal. 
Opium, conium, ether, chloroform, Calabar bean or potassium bro- 



* Guy s Hosp. Reports, XI, p. 296. 
f Medico- Legal Journal, Parker, 1885, p. 375. 
\ Schmidt's J ahrb., June, 1881, quoted by Am. J. M. Sci., April, ii 



264 MATERIA MEDICA AND THERAPEUTICS. 

mide, may also be exhibited as physiological antidotes. Recently 
Prof. Anrep * has called attention to urethan as a physiological 
antidote to strychnine and other tetanizers. 

Medicinal Uses. — This medicine is our chief resource in tor- 
pid or paralytic conditions of the motor or sensitive nerves, or of 
the muscular fibre. When, however, paralysis is the result of in- 
flammation of the nervous centres, it is injurious, and accelerates 
organic changes. It is most beneficial in those forms of paralysis 
which are independent of structural lesion, as lead palsy or paralysis 
from alcoholism. In paralysis arising from apoplexy, as hemiplegia — 
after the absorption of the effused blood, when the paralysis remains, 
as it were, from habit — the cautious employment of nux vomica is 
often attended with advantage. In amaurosis, free from cerebral 
complication, especially when due to alcohol or tobacco, it is very 
useful. In these cases strychnine is recommended in doses of gr. ^ 
injected into the corresponding temporal region. It should be ad- 
ministered daily, and the dose increased until slight twitchings of 
the muscles are produced. In atrophy of the optic nerve-fibres, it 
has not met with the success which was predicted, but is of un- 
doubted service before the stage of atrophy is reached. It has also 
been found very beneficial in chronic constipation, either alone or as 
an adjunct to cathartics: 3^ Resinae podophylli, gr. iij ; extracti 
colocynthidis compositi, gr. xij ; extracti nucis vomicae, gr. vj ; ex- 
tracti hyoscyami, gr. xxiv. M. et ft. pil. xxiv. Sig. — Take one 
pill once, twice or three times a day, as necessary. 1^ Aloin, gr. ij ; 
strychninae sulphatis, gr. ^ ; extracti belladonnas alcoholici, gr. j. 
M. et ft. pil. xxiv. Sig. — One pill after each meal, three times a 
day. As an aphrodisiac in impotence, in incontinence of urine, 
spermatorrhoea, and other affections depending on functional atony 
arid relaxation of muscular fibres, it is often highly serviceable ; in 
dyspnoea due to chronic bronchitis, dilated bronchi, emphysema, or 
incipient phthisis, it is of value as a respiratory stimulant ; it may 
be advantageously combined with digitalis when dyspnoea is due to 
cardiac disease, acting not only as a respiratory, but also as a car- 
diac stimulant ; and in pure cardiac dilation it is well to alternate 
strychnine (gr. ^V) with digitalis, giving either for a week or two at 
a time; and lastly, in combination with other remedies, as iron, in 
anemia and chlorosis : 3^ Strychninae sulphatis, gr. % 

* Bull. Gen. de Th'erap., Feb. 15th, 1887. Quoted. 



SPINANTS—NUX VOMICA. 265 

ferri chloridi, f5ij-iv ; acidi acetici diluti, f 5j ; liquoris ammonii 
acetatis, fSiij ; elixir aurantii", ad fSyj. M. et S. — Two teaspoonfuls, 
largely diluted, three times a day, after meals. ~fy Ferri sulphatis 
exsiccati, gr. xx-5ss ; quininae sulphatis, gr. xl ; strychninae sul- 
phatis, gr. ss., mannae q. s. M. ft. pil. xx. S. — One t. d. In small 
doses it has been used with excellent effect as a general tonic 
where there is loss of nerve-power, and as a stomachic in dyspepsia, 
anorexia, and to relieve the vomiting of pregnancy , for which pur- 
pose the tincture may be given in TTLJ^-j doses, repeated several 
times at intervals of half an hour. 

In the treatment of the symptoms induced by alcoholismus, 
Dobrowravovv * reports good results from the hypodermic injection 
of strychnia, his observations extending over forty cases. 

Administration. — Dose of the powder, gr. ij or iij, in pill, 
several times a day, and increased till an effect is produced; of the 
abstract, gr. ss— ij ; of the extract (alcoholic) gr. ss-j, to be repeated 
and increased; of the fluid extract, Hflj-v; of the tincture, gtt. v to 
xx, and this is sometimes used as an embrocation to paralyzed 
parts. A tolerance of nux vomica and strychnine is rapidly estab- 
lished in the system. 

Strychnina {Strychnine). The preparation and tests for this 
alkaloid have already been considered. 

The effects of strychnine are similar to those of nux vomica 
but more violent; its local action is that of an irritant. It is em- 
ployed for the same purposes as nux vomica, and should be given 
in very minute doses, as gr. ^-yV to begin with, to be gradually 
increased, carefully watching the patient and suspending its admin- 
istration as soon as twitching of the muscles, or an approach to the 
risus sardonicus, is observed. The salts of strychnine may be also 
employed in the same doses, and as they are more soluble than the 
alkaloid, they are more active. For endermic use, gr. to of the 
alkaloid may be used; when given hypodermically, as in amaurosis, 
dose, gr. fa to begin with. The salts are preferred for hypodermic 
use, because of their greater solubility. 

Strychninas Sulphas (Strychnine Sulphate) is made by dissolv- 
ing a mixture of strychnine in distilled water, with diluted sulphuric 
acid and evaporating. It occurs as a white salt, in colorless pris- 
matic crystals, efflorescent, odorless, very bitter, readily soluble in 

* Bull. Gen. de Therap., Dec. isieme, 1887, quoted. 



266 MATERIA MEDIC A AND THERAPEUTICS. 

water, sparingly soluble in alcohol, and insoluble in ether. It re- 
sponds to the tests for strychnine, anbl may be used for the same 
purposes and in the same doses. 

IGNATIA. 

The seed of Strychnos Ignatii, or St. Ignatius' Bean (Nat. Ord. 
Loganiaceae), a tree of the Philippine Islands, contains a large 
proportion of strychnine, some brucine, etc., and possesses medici- 
nal properties analogous to those of nux vomica. It may be given 
to fulfill the same remedial indications as nux vomica. An abstract 
(dose, gr. %-)) and a tincture (dose, Tftv-xx) are official. 

HYDRASTIS. 

The rhizome and rootlets of Hydrastis canadensis, Yellow 
Root or Golden Seal (Nat. Ord. Ranunculaceae), a small indigenous 
plant, with yellow, fugacious flowers, and a red fruit resembling 
raspberries, has from recent experiments been classed among the 
excito-motors. It contains the alkaloids hydrastine (C 21 H 21 N0 6 ), 
berberine (C 20 H 17 NO 4 ), and xanthopnccine* which is simply impure 
berberine; also starch, sugar, etc. (Maisch). 

Physiological Effects. — According to A. J. Slavatinski,f 
when hydrastine is given hypodermically to frogs in small doses 
(.001-002 gm.) it causes incoordination of movements, general 
sluggishness and weakness, quickened respiration, and a reduction 
of the cardiac frequency from \-\ of the normal rate, and at the 
same time the individual contractions are very energetic. When a 
larger dose (.003-.005 gm.) is given, general convulsions occur 
(resembling those caused by strychnine), which disappear on section 
of the spinal cord. The effects on the heart are intensified, and 
the cardiac action is interrupted by diastolic arrests. If a still 
larger amount (.005-.01 gm.) be given, the convulsions are followed 
by prostration, paralysis and death, the heart stopping in diastole. 
When placed on the cut-out heart, the cardiac action stopped and 
the heart could not be made to respond to further irritation. It 
probably acts on the heart not only through the par vagum, but 
also through the cardiac ganglia, and in large doses, paralyzes the 



* Proc. Amer. Pharm. Associat, 1884, p. 456 ; F. B. Power. 

f Meditz Obozr., Nov. 16, 1884, p. 346; quoted by Lond. Med. Rec, Nov. 15th, 1884, 
p. 498. 



SPLYANTS— HYDRASTIS. 267 

cardiac muscle directly. It stimulates the reflex centres of the 
cord, exalts the irritability of the motor-nerves, and probably de- 
presses the end-organs of the sensory nerves. Given to warm- 
blooded animals it slows the cardiac action, produces general de- 
pression, dis-coordination and incessant tremor; large doses cause 
death, which is due to tetanus of the respiratory muscles, and is pre- 
ceded by general paralysis. The action of hydrastis is less power- 
ful but of longer duration than that of strychnine, which it re- 
sembles. It acts, also, as a diuretic, and according to Rutherford, 
it is an hepatic stimulant of considerable power, and a feeble intes- 
tinal excitant. According to Givopiszew* hydrastis always pro- 
vokes uterine contractions, which are less intense than those of 
ergot. 

Medicinal Uses. — It is recommended as a nerve-tonic and 
anti-fermentative in atonic dyspepsia and chronic gastritis. From 
its action on the liver and intestines it is useful in duodenal catarrh, 
catarrhal jaundice, and constipation due to deficent secretion. It is 
an efficient diuretic, and has been used for this purpose in promoting 
the discharge of renal calculi from the kidneys. It is also prescribed 
in chronic cystitis, and has been employed internally and by injection 
for the cure of gonorrhoea, in the stages of decline, and in gleet, and 
also as an injection in uterine and vaginal leucorrhceas. It is an 
excellent remedy against uterine hemorrhage due to inflammation 
of the organ, coincident with the menopause or too abundant flow 
at the monthly period (Givopiszew, loc. cit.). From the study of its 
effects, it should be useful in the same class of cases in which 
strychnine is employed. 

Administration. — Dose, of the fluid extract, f5j-iv ; as a sto- 
machic tonic, TTLv-xv before meals. The tincture may be given in 
doses of 1Ux-f3J, t. d. 

As an injection in gonorrhoea, hydrastine may be used in the 
strength of gr. x-xv to mucilage f§j. 

Rhus Toxicodendron {Poison-Oak). The FRESH LEAVES of 
Rhus toxicodendron, or Poison-Oak (Nat. Ord. Terebinthacese), 
an indigenous shrub from one to three feet high. Other species 
of Rhus, possess properties somewhat analogous to those of nux 
vomica, and have been employed with success in paralysis. They 
contain toxicodendric acid, to which their poisonous and medicinal 
activity is due. Dose, gr. j-iij, or more, to be repeated and 

* These, St. Petersburg, 1887, quoted by Bull. Gen. de Therap., CXIV, 189. 



268 MATERIA MEDICA AND THERAPEUTICS. 

increased. In cases of poisoning, the irritation of the skin is relieved 
by glycerite of carbolic acid or alkaline solutions. 

COCCULUS INDICUS. 

Cocculus indicus (not official) is the dried seed of Anamirta 
paniculata {Nat. Ord. Menispermaceae), a climbing shrub of India. 
The fruit is a one-celled berry, of a dark purplish color, with a soft 
pulp, and a single seed the size of a pea, containing a bitter kernel. 
The active properties reside in a peculiar white, crystallizable bitter 
principle which is official under the name of ficrotoxinum (picrotoxin, 
C 9 H 10 O 4 ). It is partially soluble in water, and very ' soluble in 
alcohol, chloroform and ether, and in a mixture of acetic acid and 
water. Picrotoxin is not precipitated by the reagents for the 
alkaloids, and does not neutralize acids. In the shell, an alkaloid 
termed menispermine has been found, and a neutral principle of the 
same composition as the alkaloid, termed paramcnispermin. 

Aids. — The spinants, as strychnine, brucine, and ergot. In its 
action on the secretions, it is allied to pilocarpia and muscarine. 

Effects and Uses. — Picrotoxin is an acrid cerebro-spinal 
narcotic, capable, in large doses, of producing death by tetanic 
fixation of the respiratory muscles. Its cerebral effects are variously 
described, such as stupor, giddiness and vertigo. In doses suffi- 
cient to produce these effects it is apt to nauseate. It is a tetani- 
zing agent, the tetanus being followed by convulsions, paralysis and 
coma. According to Chirone* the chief action of the drug appears 
to be that of an excitant of the centres located in the medulla 
oblongata and spinal cord. The convulsions can be brought on in 
an animal from which the brain has been removed. Picrotoxin is 
capable of originating an artificial epilepsy, and it acts independ- 
ently of the psycho-motor centres, its influence being most decided 
when they are removed. During the conclusive stage the heart's 
action increases, while in the stage of coma it becomes slow, and 
after death it is found to be in diastole. Picrotoxin induces decided 
diaphoresis. In rare instances it has destroyed human life. In cases of 
poisoning by picrotoxin, chloral, ether by inhalation, and the motor- 
depressants are to be given. It has not been much used internally, 
except in the night-sweats of phthisis, for which Murrellf recom- 

* Anuali Univer. di Med. e Chirurgia, vol. 251, 1880, p. 289. Ricerche sperimentali 
sull'azione biologica della picrotoxina ; per V. Chirone. 
f Lancet, London, 1890. 



SPINA NTS—ER GOT. 269 

but in the form of decoction or 
ointment it is employed to destroy pcdiculi and other parasites, and 
for the cure of tinea capitis and porrigo of the scalp. It is said to 
prevent the secondary fermentation of malt-liquors, into which it is 
sometimes introduced as an adulteration. 

ERGOTA ERGOT. 

Ergot is a fungus growing from the diseased ovary of Secale 
cereale, or Rye (Nat. Ord. Graminaceae). The U. S. Pharmacopoeia 
styles it the Sclerotium of Claviceps Purpurea [Nat. Ord. 
Fungi), replacing the grain of Secale cereale. In the production of 
ergot there are three stages, as follows : 1st, in the flowering season 
one or more ovaries in an ear of rye are covered by a sweet yellow- 
ish mucus — the honey dew of rye — which contains numerous micro- 
scopic cells called conidia, a sugar, and which is the product of the 
decomposition of the constituents of the ovary caused by the 
developing mycelium of the fungus. This is formed of filamentous 
cells termed hyphce, and the first stage ends when the hyphae have 
penetrated the ovary and separation of the conidia have ceased. 2d, 
when the hyphae unite at the base of the ovary into a purplish- 
black body (ergot) extending to the apex of the grain. 3d, 
the development of the fungus is completed. It will be seen that 
ergot is the dormant or intermediate stage of a fungus called 
Sclerotium, compound mycelium or spawn. Its predisposing cause 
is unknown, and it is not peculiar to rye, many other grasses being 
subject to it, as abortion in grazing animals has been frequently 
produced by their eating grasses affected with ergot. The ergot 
usually projects out of the glum or husk of the plant, beyond the 
ordinary outline of the spike or ear. It should not be collected 
until some days alter it has begun to form, as it is thought not to 
possess full activity until about the sixth day of its formation. As 
found in the shops it consists of cylindrical or somewhat prismatical 
tapering grains, curved like the spur of a cock, of a purplish color 
externally, and of a yellowish or grayish-white color within. Its 
smell is peculiar and nauseous ; its taste is at first faint, but becomes 
bitterish, acrid and disagreeable. It yields its virtues to water and 
alcohol, and does not keep well, being liable to the attacks of a 
minute worm. It deteriorates much more rapidly in powder than 
when in grain, in the former condition soon becoming inert. 

Chemical Constituents. — Numerous analyses have been made 



270 



MATERIA MEDIC A AND THERAPELTICS. 



of ergot, but there is still some uncertainty as regards its active prin- 
ciples, though this is gradually growing less. The investigations of 
Dragendorff seem to show that the specific effects of the drug 
depend in a high degree upon a proximate principle of an acid 



FIG. 22. 




SECALE CEREALE. A. A. ERGOT. 



character, to which the name of sclerotic acid is given : this, how- 
ever, has not been confirmed. It is odorless and tasteless, soluble 
in water and boiling alcohol, but not at all in cold alcohol. Good 
ergot contains from 4 to 4.5 per cent, of the acid. The most reli- 



SPINA NTS— ERGOT. 271 

able investigations upon this question are those of Kobert,* which 
point to the following conclusions : viz., that ergot does not owe its 
ecbolic power to ergotinic acid, which has no influence on the 
uterus, but that sphacelinic acid, a resinous body insoluble in water, 
never failed to produce powerful contractions in the gravid uterus, 
and lastly that cornutin, gr. yi, either in the pregnant or non-preg- 
nant uterus, always exhibited the same action. According to this 
observer, the only active preparation is one containing both cornu- 
tin and sphacelinic acid, and that no sample of ergot, either Euro- 
pean or American, retained its virtues for more than 12 months. 
Ergot also contains scleromucin (2 to 3 per cent.), sclererytherin, 
scleroiodin, picrosclcrotin (poisonous), sclerocrystallin, and scleroxan- 
thiii (inert), and an alkaloid, crgotinine (Maisch). 

Incompatibles. — Forms a clear solution with liquor potassfe ; 
tannin throws down a copious precipitate; with ferric chloride its 
solution is much darkened. 

Aids. — Ustilago and gossypium enhance its action of contrac- 
tion upon the uterus. 

Physiological Effects. — The effects of ergot are not well un- 
derstood, especially as regards its action on the nervous system. 
In medicinal doses it acts most conspicuously on the circulation 
and on the female system, in which it excites powerful contractions 
of the uterus. After labor has commenced, in ten or twenty minutes 
from its administration, it increases the violence, frequency and con- 
tinuance of labor-pains, which usually never cease until the child is 
born. Administered before labor, it frequently originates the process, 
though its effects in this respect are less constant. And even in 
the unimpregnated utei'us it produces painful contractions, and 
evinces an influence over morbid conditions of the organ by check- 
ing uterine hemorrhage and expelling polypi. Ergot induces f 
contraction of the unstriped muscular fibre wherever found, causing 
a shrinkage in the calibre of the blood-vessels everywhere, and it is 
thus available generally as a remedy in cerebral and spinal conges- 
tions, hemorrhages, tumors, morbid growths and enlargements. In 
large doses it produces vomiting, purging, increased peristalsis, and 



* The Practitioner, Dec, 1885, p. 414 : and Arch, fur Exp. Pathol, u. Pharmakol., 
1884, xvii, p. 316. ..._.. 

f Arch, de Physiol. Norm, et Pathol., iii, 1870, p. 584. Effets de 1' extrait d'ergot sur 
la pression arterielle ; par Ch. L. Holmes. 



272 MATERIA MEDIC A AND THERAPEUTICS. 

a marked sedative * effect on the circulation, slowing the heart 
(10-36 beats), probably by direct action on the cardiac muscle, and 
causing an enormous rise in the blood-pressure, through the con- 
traction of the arterioles and stimulation of the vaso-motor centres 
of the cord and medulla; decided toxic doses lower the blood-pres- 
sure, by depressing the heart and vaso-motor centres (Brown- 
Sequard). In excessive quantities it acts as an acro-narcotic poison 
on both sexes. When it is used for a length of time as an article 
of food it produces a peculiar morbid condition, termed ergotism, 
which assumes two forms, one attended with convulsions, the other 
with dry gangrene of the limbs. 

Medicinal Uses. — From its action on the pregnant uterus, 
ergot has long been used in obstetric practice. With few excep- 
tions ergot had better not be administered while any product of 
conception remains within the uterine cavity, because, while causing 
contraction of the muscular fibres of the fundus, which would pro- 
duce expulsion of the uterine contents, it also causes contraction of 
the sphincter-like fibres of the cervix, and thus presents an obstacle 
to the emptying of the uterus. As the intermittent contractions of 
the uterus become continuous and tetanic under the influence of a 
large dose of ergot, it is obvious that rupture of the uterus may oc- 
cur if the resistance offered to the expulsion of the uterine contents 
be sufficiently great. Partly on this account, and partly because the 
tetanic contraction of the uterus induced by ergot would interfere 
with the circulation of the foetus, it should never be administered 
during the first stage of labor. During the second stage of labor, 
it may be given if the expulsive pains are feeble and inefficient 
(uterine inertia), when there is a proper conformation of the pelvis 
and soft parts, when the os uteri, vagina, and os externum are dilated 
or readily dilatable, and when the presentation of the child is such as 
to offer no great mechanical impediment to speedy delivery. In these 
cases it is best to administer it in small doses (Tftviij-x of the fluid 
extract), as when thus given it simply intensifies the natural uterine 
contractions without causing them to become continuous. It has 
also been used in the second stage of labor in women subject to 
flooding, given just before delivery, but even in these cases it is 
better to withhold the drug until the placenta is expelled, as 



* Bull. G&n. de Therap., lxxviii, pp. 433, 481. Ergot, ergotine, action physiol., etc. 
M. Bailley. 



SPINA NTS—ER GOT. 273 

otherwise the uniform contraction induced may lead to its reten- 
tion. 

After the third stage of labor is completed, if hemorrhage is 
likely to occur from uterine inertia, ergot is one of the best remedies 
we possess, as the tetanic contractions which it produces perma- 
nently arrest the bleeding by compressing the orifices of the vessels. 
Ergot exercises a dangerous sedative influence on the child during 
labor (owing to the interference of the passage of blood from the 
placenta during violent uterine contraction), and its use may some- 
times produce fcetal death, if the obstetrician is not careful to listen 
frequently to the fcetal heart, and deliver with the forceps should 
any sign of asphyxia be present (Spiegelberg). It has been used 
in the hemorrhage due to abortion, but as the bleeding will only 
stop when the uterine cavity is empty, and as ergot delays this by 
preventing dilatation of the cervix, the tampon and other means are 
preferable. When, after an abortion, the placenta is retained by 
adhesions so firm that it is impossible to destroy them, a tampon 
may be employed and ergot given simultaneously. 

Ergot has also been used to cause the expulsion of polypi, and 
even of interstitial fibroids from the uterus. In speaking of its ad- 
ministration in the latter class of tumors, Emmet* says : It should 
never be given in large doses until after the uterine canal has been 
dilated, and until it is found that the tumor projects sufficiently to 
warrant the belief that it may become pedunculated by uterine con- 
traction." By neglecting these cautions he has seen peritonitis 
produced. It is best to administer it hypodermically in these cases. 
In subinvolution, especially when menorrhagia is present, ergot com- 
bined with potassium bromide is useful. For its action on unstriped 
muscular fibres it is much employed in hemorrhage generally; in 
congestive dysmenorrhea ; hematuria; paralysis of the bladder, 
especially when due to over-distention ; purpura ; and diabetes in- 
sipidus ; by hypodermic injection, in the cure of aneurism and varix, 
and as a means of checking hemoptysis. It is also used in intestinal 
and uterine hemorrhage. In hematemesis it may also be employed, 
but is inferior to other remedies. In paralysis dependent upon con- 
gestion of the spinal cord as in spinal me7tigitis, and in acute myelitis, 
it is often of great service. 

Administration. — Ergot may be given in labor, in the dose 



Princip. and Practice of Gynaecol." 3d ed., p. 567. 



274 MATERIA MEDICA AND THERAPEUTICS. 

of gr. v-xx, in powder, every twenty minutes, till its' effects are 
produced, or three doses are taken : in other diseases the dose is 
from gr. iij-x. It may be safely given, in chronic diseases, for a 
long period, without danger of ergotism; the indication of the 
maximum dose having been reached in the female is the produc- 
tion of uterine colic, when the quantity should be diminished. The 
fluid extract is the best preparation ; dose, TTLv-fSj or more.* The 
extract is made by the evaporation of 500 parts of fluid extract over 
a water-bath at a temperature not exceeding 122 F. until it is re- 
duced to 100 parts; dose, gr. v-xv. The wine (vinum ergotcz) 
contains powdered ergot, 15 parts, in 100 parts by weight of the 
preparation. Dose, f5j-iv. The preparations used under the name 
of ergotine are of uncertain strength. 

USTILAGO. 

Ustilago maydis [Nat. Ord. Fungi), Corn-Smut or Corn-Ergot, 
is a fungoid growth upon the Zea Mays or Indian Corn (Nat. Ord. 
Graminaceae). It has been known to exist for more than one 
hundred years, having been described by Pujolf in the last century. 
It is found in irregular masses in the Northern States, \ during the 
middle and latter part of summer, growing most frequently upon 
the young ears and tassels, the leaves being usually exempt, and 
consisting of a blackish gelatinous membrane, inclosing numerous 
dark globular and nodular spores, which break up like a great puff- 
ball, discharging a cloud of brownish impalpable dust of narcotic 
odor. It has a disagreeable odor and taste, and contains a fixed 
oil, probably sclerotic acid, a crystalline principle, etc. (Maisch). 

Aids. — Upon the uterus, ergot and gossypium. 

Effects and Uses. — J. Mitchell§ has investigated its action 
upon frogs with the following results: By injection it induces 
tremors and clonic spasms ; increased doses cause irregular respira- 
tion, weakened muscular movements, spasms, palsy and death, the 
latter due to paralysis of respiration ; the heart continues to beat 



* For hypodermic use, the fluid extract should be reduced by evaporation to one-sixth 
of its weight, and sixty grains of this extract should be dissolved in four fluidrachms of 
water ; four minims of this aqueous solution represent one grain of extract and six grains of 
ergot ; or the fluid extract may be carefully filtered, and used in doses of TIX X > or ^he ex- 
tract may be dissolved in water and filtered ; it is five times as strong as the fluid extract. 

-f- Jourti. de Medecine, 1774, I, p. 145. 

% Therap. Gaz., 1881. Prof. Spalding. 

g Ibidem, 1886, p. 223. 



SPINANTS—BARK OF COTTON ROOT. 275 

after life is apparently extinct. Lethal amounts abolish all move- 
ments, suspend reflex action, and contract the pupils. The sus- 
pension of reflex action is due to paralysis of the sensory part of 
the cord, though the motor-tracts, too, are depressed. No state- 
ment of its action on muscular fibre of either kind has been come 
across, though Dr. Steel* noticed that abortion was common in 
cows when turned into fields to feed, unless the corn smut had 
been removed, which indicates an action of contraction upon the 
muscular structure of the uterus. 

The uses of ustilago resemble those of ergot, and it has been 
successfully employed in the same class of cases. (Midwifery — 
Drs. Vernon f and Rouse. J) Dose of the fluid extract (not offi- 
cial), gtt. x-xx. 

GOSSYPII RADICIS CORTEX— BARK OF COTTON ROOT. 

Gossypium herbaceum (Nat. Ord. Malvaceae) is a native of 
Asia, cultivated extensively in tropical and semi-tropical countries, 
and with great success in the South Atlantic and Gulf districts of 
the United States. By cultivation, different varieties of this plant 
have been produced. The root should be collected immediately 
after the cotton is harvested, and the root-bark should be of a 
yellowish-brown color externally, internally much lighter; when 
chewed, it has a slightly sweetish, astringent taste. It contains 
chromogene (when fresh), becoming a red resin, a yellow resinous 
coloring matter, fixed oil, gum, sugar, tannic acid, etc. 

Aids. — Upon the uterus ergot and ustilago. 

Effects and Uses. — Gossypium has long been recognized by 
Southern physicians as possessing a decided influence in exciting 
uterine contractions. Dr. J. C. Martin, § from experiments on frogs, 
rabbits, and guinea-pigs, concludes that it has no action on the 
motor or sensory nerves, nor on the reflex functions, and that the 
circulation and muscles are uninfluenced by it. 

The most recent investigations, furthermore, show that in large 
doses it kills by paralysis of respiration, often preceded by clonic 



* Trans. Wisconsin State Med. Society, 1878, p. 127. 
f Chicago Med. Times, II, 1879-80, p 434. 
\ Therap. Gaz., 1886, p. 163. 

§ Am. Journ. Med. Sciences, Jan., 1882. An investigation of the physiological effects 
of Gossypium Herbaceum. 



276 MATERIA MEDICA AND THERAPEUTICS. 

convulsions not prevented by section of the cord ; the reflex centres 
of the cord are depressed, but the motor and sensory nerves are not 
affected. The blood-pressure falls, from depression or paralysis of 
the vaso-motor centres, this fall being preceded by a rise in 
pressure if the dose be small. In large amounts it causes great 
venous congestion and tension, stimulates and then paralyzes the 
cardio-inhibitory apparatus and depresses the cardio-motor ganglia, 
thus at first retarding and then accelerating the pulse, which is 
always weakened. The pupil is always dilated. It stimulates mus- 
cular action, especially that of the unstriated variety. It often 
causes vomiting and purging. In cats and rabbits, gossypium 
causes, in small and repeated doses, intermittent rhythmical con- 
tractions of the gravid uterus, leading to complete expulsion of its 
contents, and it has been seen to increase the uterine contractions 
when administered after their inception. * Prochovnik finds it an 
efficient substitute for ergot, although its expulsive power is not so 
great. He recommends it especially in hemorrhage after abortion, 
and in uterine myoma. The only official preparation is the fluid 
extract (which, when first prepared, is of a brownish-yellow color, 
changing, however, to a bright red) ; dose, f5ss. 

Gossypium (Cotton), the well-known filamentous substance sepa- 
rated from the seed of the varieties of gossypium, is a useful 
application to burns and parts affected with erysipelas and rheuma- 
tism, either suitably medicated or alone, and is much used as a dress- 
ing in various surgical affections, and after operations. Deprived 
of oily matters by boiling with an alkali, it is known as absorbent 
cotton, and when thus prepared should take up about fifteen times 
its weight of water. By exposure to high dry heat it may be ren- 
dered free of disease-germs, and then it forms the antiseptic cotton of 
modern surgery. Impregnated with iodoform, cotton may be packed 
in the vagina as a tampon, in various uterine hemorrhages (as in 
threatened abortion, etc.), or to give support and correct dis- 
placement in cases of version of the uterus. It is particularly 
adapted to those cases where, from inflammation or tenderness of 
parts, an ordinary pessary could not be worn. It is also impreg- 
nated with carbolic, salicylic, boric acid y or corrosive sublimate, for 
use as a surgical dressing. 



* " Gossypium Herbaceum." Thesis by Thos. Harry Huzza, M.D., awarded the Medi- 
cal News prize at the Jefferson Medical College, of Philadelphia, 1887. 



SPINANTS— DIGITALIS. 



277 



DIGITALIS. 

Digitalis purpurea, or Purple Foxglove [Nat. Ord. Scrophulari- 
aceae), is a biennial European plant, cultivated in our gardens, with 
an erect stem three or four feet high, large ovate-lanceolate, crenate, 
downy and veiny leaves, of a dull green color, and handsome bell- 
shaped crimson or purple flowers, arranged in a large terminal 
spike. The seeds and leaves are both active, but the latter only 
are employed, from plants of the second years growth ; and those 
from the European wild plants are preferred, as the cultivated 



fig. 23. 



^■-n 




DIGITALIS PURPUREA, A. LEAF ; B. FLOWERS. 



variety is thought to be inferior in virtue. The English digitalis- 
leaves are superior to the German because they are carefully 
selected and freed from the stalks, which do not represent 
the activity of the plant. The petioles are removed, and the 
leaves are then dried in baskets, in a dark place, in a drying- 
stove. When dried, they have a dull-green color, with a faint odor 
and a bitter, nauseous taste, and afford a fine deep-green powder. 
Both leaves and powder should be preserved in well-stoppered 
bottles covered externally with dark-colored paper, and kept in a 



278 MATERIA MEDICA AND THERAPEUTICS. 

dark cupboard, and, as their medicinal activity is impaired by keep- 
ing, they should be renewed annually. 

Chemical Constituents. — The leaves contain numerous so- 
called principles, among which are digitalin, digitoxin, digitonin, 
and digitalein : many of these are the result of decomposition, 
either during plant-life, or during the treatment of the extract or 
exhaustion of the plant. They are all glucosides except digitoxin. 
By digitalin is meant the product obtained by Schmiedeberg in 
1874. The digitalis -principles may be arranged according to their 
solubility; viz., those soluble in alcohol and almost insoluble in 
water (digitalin and digitoxin) ; and those miscible both in alcohol 
and water (digitonin and digitalein). Consequently such prepara- 
tions as the tincture and fluid extract contain the most digitalin and 
digitoxin ; the infusion, digitonin and digitalein. Digitonin is said 
to resemble saponin, but differs from it in its behavior to chemical 
reagents. The other constituents are inosit, pectin, resin, the digi- 
talic acids, and fixed oil (about 5 per cent). Digitalin and digitoxin 
are the most active ingredients of the plant. 

Digitalin, when perfectly pure, occurs as fine, white, glittering 
hygroscopic needles, or groups of crystalline tufts, odorless, but of 
a very bitter taste ; readily soluble in alcohol, chloroform and warm 
acetic acid, but nearly insoluble in water and ether ; dose, from ^\ 
to 3V of a grain. A dose above gr. T V causes purging and vomiting. 

Tests. — Chemical analysis affords no certain tests of the pres- 
ence of digitalis or its active principle, even Grandeau's method of 
isolating digitalin by dialysis being uncertain, and in cases of sus- 
pected poisoning the physiological test must be resorted to. This, 
however, is not proof positive of its presence, for Fagge and Steven- 
son * have shown that digitalis is only one of a small class of sub- 
stances (as helleborus viridis and scilla) the action of which on the 
frog's heart appears to be identical. These they termed cardiac 
poisons. In every experiment they caused cardiac irregularity, 
followed by stoppage of its pulsations in rigid ventricular contrac- 
tion. In the celebrated Pommerais case, the criminal was condemned 
from the evidence derived from the administration of an extract ob- 
tained from the stomach and bowels of the deceased party, to small 
animals, in whom were produced vomiting and marked diminution 



* Proc. Royal Society, xiv, p. 270. On the application of Physiological Tests for Cer- 
tain Organic Poisons, especially Digitaline. 



SPINANTS—DIGITA LIS. 279 

of the number of heart-beats, with intermittent and irregular 
action. 

Incompatibles. — Forms an inky mixture with ferric chloride 
and sulphate ; with compound tincture of cinchona and tannin a 
precipitate goes down ; lead subacetate and acetate produce a 
copious precipitate. The precipitation with the iron and lead salts 
is due to combination with the digitalis-acids. 

Aids. — Upon the heart and vessels, adonidin, strophanthus, 
sparteine, cimicifuga, and ergot. 

Physiological Effects. — Though the action of digitalis is 
directed chiefly to the circulatory apparatus, yet in lethal quantity 
other phenomena are induced, as follows. Nervous system : in 
toxic doses, digitalis lowers reflex activity by exciting Setschenow's 
inhibitor^ reflex centre, and, after a time, paralyzing the spinal cord 
(A. Weil), causing prostration, muscular tremors and sometimes 
convulsions. Circulation : its action here has been investigated by 
Vulpian, Pelikan, Homolle, * Gaskell f and others, with the follow- 
ing results, viz. : that it lessens the number of cardiac pulsations, 
prolonging the diastole, energizing the systole, and finally paralyzing 
the heart in systole ; this is produced by direct stimulation % of the 
cardiac muscle, and possibly of the contained motor-ganglia, as well 
of the peripheral inhibitory fibres of the pneumogastric. Moderate 
doses cause a rise in the arterial pressure, probably by contracting 
the arterioles, through stimulation of the vaso-motor centres of the 
cord ; after large doses the pulse becomes dicrotic from irregular 
ventricular contraction ; toxic doses, or, when the heart is much de- 
pressed, a sudden change from the recumbent to the erect position, 
may cause a frequent, weak and small pulse, with lowered blood- 
pressure. An entirely satisfactory explanation of the modus operandi 
of digitalis on the circulatory apparatus has not so far been made. 
The influence of digitalis over the pulse is more marked in weak 
and debilitated persons, than in those who are robust and plethoric. 
Its effects, too, in this particular are more easily obtained in the re- 
cumbent than in the erect posture, owing to the less force required 



* Arch. Gen. de Medecine, xvill, p. 5. Exper. physiol. sur quelques preparat. de 
cLgitale. 

f The Journ. of Physiology, III, p. 48. On the Tonicity of the Heart and Blood 
Vessels. 

% Proc. o' the Royal Med. and Surg. Soc, I, 1882-5. Investigations into the Action of 
the Digitalis Group. Ringer and Sainsbury. 



280 MATERIA MEDICA AND THERAPEUTICS. 

in the former position to carry on the circulation. In the repeated 
use of small doses of this medicine, a cumulative effect is sometimes 
observed : its powers are not manifested for a certain time, and 
effects are suddenly produced, which are attributable to the whole 
amount administered, acting together, by failure of excretion, giv- 
ing rise to dangerous and even fatal syncope. In morbid condi- 
tions of the circulation, where it is irritable, abnormally quick or 
irregular, digitalis is considered to exercise a primary medicinal 
effect in steadying the pulse and restoring its force and regularity, 
while it diminishes morbid frequency. Where the temperature of 
the body is abnormally increased, digitalis, in large doses, will 
diminish it. From its action on unstriated muscular fibres, digitalis 
has the property of stimulating the uterus to contraction. As re- 
gards its diuretic action, it is probably rather indirect than direct, 
and is most conspicuous where dropsical effusions are removed 
under its influence. Brunton has, however, shown that in dropsies 
it acts directly on the Malpighian tufts, independently of the blood- 
pressure ; also, that when taken for a .long time, and accumulating 
in the blood, it diminishes the urinary flow by contraction of the 
renal vessels. It increases the amount of solids eliminated in the 
urine, except that of urea and uric acid, which are diminished under 
its use. In health, the action of digitalis upon the quantity of 
urine is uncertain. 

Toxicology. — When too long continued, or taken in excessive 
doses, digitalis acts as an acro-narcotic poison, producing vomiting, 
purging, irregular, feeble and rapid cardiac action, severe abdominal 
pains, vertigo, disordered vision, dilated pupils, syncope, and finally 
delirium and stupor, death being usually preceded by convulsions. 
The quantity of digitalis, however, that may be given, especially in 
disease, without destroying life, is considerable. According to 
Woodman and Tidy about gr. ^ of digitalin would prove fatal, and 
a toxic amount rarely kills in less than 24 hours. 

Antidotes. — In such cases, after evacuating the stomach, the 
diffusible stimuli, as brandy and ammonium carbonate, should be ad- 
ministered. Opium, aconite, etc., antagonize to some extent the action 
of digitalis ; the most complete antagonism exists between digitalis 
and saponin, the active principle of Saponaria officinalis (Kohler). 

Medicinal Uses. — From its action on the circulation, digitalis 
has been used in adynamic fevers and inflammations, and in hemor- 
rhages, especially that of menorrhagia, and in post-partum hemor- 



SPINANTS— DIGITALIS. 281 

rJiagcs. In hectic fever, it is often combined with quinine, and if it do 
not disorder the digestion, it is generally of great value : 1^ Quininae 
sulphatis, gr. xxiv ; pulveris digitalis, gr. viij ; pulveris opii, gr. vj. 
M. et ft. pil. xxiv. Sig. — Take one pill 3 or 4 times a day. In fevers 
accompanied by a high temperature, as scarlatina and typhoid fever \ 
it is specially useful. In the treatment of diseases of the heart and 
great vessels, it is a remedy of the greatest value, but it is to be pre- 
scribed with discrimination. In dilatation of the heart, in fatty de- 
generation, and in irritability of heart-action generally, digitalis, by 
increasing the force of the cardiac contractions and by abating ir- 
regular movement, is always useful ; in uncomplicated hypertrophy 
it is objectionable. In valvular regurgitation, aortic or mitral, if the 
heart's action be feeble its administration is called for, particularly 
if accompanied by dyspncea and dropsy, and when so indicated it 
should be given in doses large enough to produce its physiological 
effect, viz., to increase the force but reduce the number of pulsations, 
to raise the arterial tension, and augment the urinary flow. At the 
same time the bowels must be kept freely opened with the hydra- 
gogues, and sufficient rest in the recumbent position enjoined as the 
case may seem to require. In cases of sudden syncope from any 
cause, a hypodermic injection of the tincture Tftx-xx, repeated, if 
necessary, in half an hour, may be advantageously administered. 
H. C. Wood states that he has never seen any severe local irritation 
follow this use of the tincture, which also accords with the observa- 
tions of others in several cases. In aortic constriction, if the heart's 
action be feeble, it is indicated. 

It is greatly esteemed in the treatment of ascites and dropsy ; 
and in the varieties of this disorder resulting from heart-disease the 
infusion of digitalis is more employed than any other remedy, from its 
combined cardiac and diuretic influence. In these conditions it may 
often be advantageously combined with iron. B^ Pulveris digitalis, 
gr. xv ; ferri sulphatis exsiccati, gr. x ; quininae sulphatis, gr. xx ; 
oleoresinae capsici, gr. iij. M. et ft. pil. xx. Sig. — Take one pill 
three times a day ; or the infusion may be alternated with a mixture 
containing tincture of ferric chloride. It is a valuable remedy in 
acute Bright s disease, especially when dropsy is present, and also in 
chronic Bright s disease of the kidney under like circumstances. In 
delirium tremens digitalis has been given in large doses, with ex- 
cellent effect, and it occasionally proves efficient as a heart tonic 
in that obstinate condition known as exophthalmic goitre. 



282 MATERIA MEDICA AND THERAPEUTICS, 

Administration. — Digitalis may be given in powder, of which 
the dose is gr. j two or three times a day, to be graduaily increased. 
The official preparations are the abstract, dose, gr. ss-j ; the infusion* 
(powdered digitalis and cinnamon each 3 parts, macerated in 185 
parts of boiling water for 2 hours, then strained and 15 parts 
of alcohol passed through the strainer, and water enough to make 
200 parts), dose, f5ij-iv; the tincture, dose, TTLv-f5j; the extract 
(alcoholic), dose, gr. J^, gradually increased; the fluid extract, dose, 
Htj to begin with. If digitalis produce wakefulness, a little opium 
may be combined with it. 

ADONIDIN. 

Adonidin (not official) is a glucoside, obtained from the root of 
Adonis vernalis {Nat. Ord. Ranunculaceae), a plant of central Eu- 
rope. It was first isolated by Cervello, f and is an amorphous sub- 
stance, odorless, colorless, but having an intensely bitter taste, 
soluble in alcohol, but slightly soluble in ether and water.}; 

Aids. — See digitalis. 

Effects and Uses. — Adonidin is almost identical in action with 
digitalis,! strengthening the cardiac energy, while diminishing its 
frequency by prolonging the diastole, thus allowing the engorged 
veins time to empty themselves, and at the same time raising 
the arterial tension by contracting the arterioles. It acts more 
quickly on the heart than digitalis, and is not so apt to disorder the 
stomach and bowels (Cervello, Durand), although these effects are 
sometimes observed. 

According to most authorities it possesses considerable diu- 
retic powers, increasing both the water and the solids of the urine. 



* The following formula for infusion of digitalis is proposed by J. W. England, 
Ph.G. {Am. Journ. Pharm., July, 1892): Take of digitalis leaves, bruised, gr. 120; 
water, f^ 14^ ; ammonia water, tTt9 > alcohol, f^j. Macerate for an hour, agitating 
well occasionally, filter, express residue, wash with water, and filter, to make f ^ 14^. 
Now add TTt9° °f ammonia water, alcohol f ^ i, and sufficient water to make the volume 
measure one pint. The ammonia water is added to prevent decomposition; and cold- 
water maceration employed because it dissolves more of the active and less of the color- 
ing principles. 

f Archiv fur Experiment. Pathol, und Pharmakol., 1882, p. 338. 

J "Poisons; their Effects and Detection," by Alexander Wynter Blyth. Am. Ed. 
p. 396. 

§ V. Cervello, op. cit. and La Med. Contempt July and Aug. 1885. E. Durand, Journ. 
de Med., Dec, 1885, and These de Paris, 1886. Bubnow. Centralbl. fur die gesammte 
Therapie, 1885. Houchard, Gaz. Hebdomadaire, Jan. 1st, 1886. 



SPINANTS—STROPHANTHUS. 283 

It is rapidly eliminated, and has no cumulative action (Cervello). 
According to Hare,* in all doses it heightens the arterial tension by 
stimulating the vaso-motor centres and increasing the force of the 
cardiac contractions; large doses slow the heart by stimulating the 
vagus, which finally becomes paralyzed, the pulse rate being then 
accelerated. 

Adonidin may be used for the same purpose as digitalis, par- 
ticularly mitral regurgitation, to which, however, it is inferior. When 
the latter is contraindicated from some idiosyncrasy on the part of 
the patient, or when it disorders the stomach, or if its action be not 
sufficiently rapid, adonidin may be substituted with advantage. It 
may, too, be alternated with digitalis, giving either for a few weeks 
at a time. ■ Dose, gr. y&—y& in compressed pill or capsule. 

STROPHANTHUS. 

Strophanthus (not official) is the seed of the Strophanthus his- 
pidus {Nat. Ord. Apocynaceae), a plant distributed along the coast 
of Africa, between Senegambia and Lower Guinea. It is described 
by Blondelf as a branchy bush growing to the height of three or 
four metres, which gives off yellowish-white flowers, appearing in 
April or May, arranged in terminal cymes. The seed is con- 
tained in a thin cylindrical pod, the length of which varies between 
25 and 50 centimeters. They are from 10 to 14 millimetres in length 
and consist of a tiny tuft supported on a slender stalk These seeds, 
coarsely powdered and made into a paste, are used by the natives 
to poison their arrows, and are called Combe, Kombe, or Inee. 
From strophanthus Dr. Thomas B. FraserJ has isolated a crystalline 
glucoside, which he calls strophanthin (C 31 H 48 12 ), and to which the 
effects of the seed are due. It is non-nitrogenous ; of a strongly- 
bitter taste and feebly-acid reaction, and is freely soluble in water, 
in rectified spirits, but not in ether. 

Aids. — Digitalis, adonidin, and sparteine. 

Effects and Uses. — Pelikan in 1865 called attention to stro- 
phanthus as a powerful cardiac poison, and his researches were con- 
firmed by Fraser,§ Corville,|| and others. When introduced into 



* Therap. Gaz., Apr. 15th, 1886. f Bull.' Gen. de Therap., Fevrier, 1888, p. 97. 

% Brit. Med. Journ., Nov. 14th, 1885. 

\ Op. cit.\ also Proc. Royal Soc, 1879; Journ. Anat. and Phys., 1872; Brit. Med. 
Journ., Jan. 22a!, 1887, and a monograph by Fraser u on the action of the digitalis group," 
containing a reprint of foregoing articles. I| Med. Digest, Sec. 393 ; 1, 1872. 



284 MATERIA MEDICA AND THERAPEUTICS. 

the system it increases the strength of the cardiac systole, while 
prolonging the diastole, and in over-doses arrests the heart in rigid 
systolic contraction. It is a muscle-poison, increasing the contracting 
power of all the striated muscles, and rendering their contractions 
more complete and prolonged, but the heart is easier influenced by 
it than are other muscles, and the dose may be so regulated that the 
cardiac effects are alone produced. It also contracts the arterioles 
somewhat, but not to the same extent as does digitalis. It pro- 
duces a slight lowering of temperature and is a diuretic* It rarely 
causes vomiting, and has no cumulative action. 

Strophanthus, or strophanthin has been used as a substitute for 
digitalis, as in mitral regurgitation, when the latter disagrees, or was 
objectionable from its effect in contracting the arterioles and thus 
throwing more work on an already overtaxed heart. 

A tincture (i to 20 parts in weight) is recommended by Prof. 
Fraser, of which the dose is Htj-xx, t. d. 

Of strophanthin, gr. x \^—h may be given hypo dermic ally. 

SPARTEINE. 

Sparteine (C 15 H 26 N 2 ) is an alkaloid obtained from Sarothamnus 
Scoparius, or Broom {Nat. Ord. Leguminosae), and occurs as a 
strongly alkaline, dense oily liquid, but slightly soluble in water, 
readily soluble in alcohol, ether and chloroform, having an intensely 
bitter taste and an aniline-like odor. It combines readily with acids 
to form salts, which are preferred for medicinal use because they 
are more readily soluble. 

Aids. — Digitalis, strophanthus, and adonidin. 

Physiological Effects. — Like the other members of the 
digitalis group, sparteine is a cardiac tonic, acting through the cen- 
tral nervous system, increasing the intensity and persistence of 
the ventricular contractions and regulating the cardiac rhythm. t 

In large doses it completely paralyzes the motor-nerves and 
diminishes reflex action (Fick). It does not appear to affect mus- 
cular contractility. Sparteine is probably not the diuretic principle 
of Scoparius, and according to most observers has no effect on the 
urine, although Fick asserts that it increases diuresis. It does not 



* Bull. Gen. de Therap., Aout 23d, 1888, Lemoine. Ibid. t. 116, p. 69, 1889, Egasse. 

f Archlv fur Experi?nent. Pathol, und Pharmacol., Fick. Band 1, p. 397. These, 
Montpellier, 1887 ; " La Sparteine et ses Sels,' par P. Dandrieu. Gaz. Hebdom., Nov. 27th, 
188^, Germain See, et al. 



SPINA NTS— CIMICIFl GA. 285 

disorder the stomach, has no cumulative action, and acts on the 
heart more»promptly than digitalis (See). In overdoses it is capa- 
ble of causing a fatal result, death being due to paralysis of the 
respiratory centre, and preceded by a stage of excitement, quickly 
followed by collapse. Poisoning from sparteine should be treated 
by artificial respiration and electricity applied over the vagi ; and if 
it has been taken by the mouth in the form of sulphate, potassic 
iodide in aqueous solution should be administered, as in the presence 
of water this seems to form an almost insoluble salt (Dandrieu), 
and in any event elimination should be favored by diuretics and 
diluents. 

Medicinal Uses. — It has been used with success in cases of 
weak, feeble and irregular heart, particularly when the cardiac 
rhythm is disturbed. It is employed as a substitute for digitalis in 
mitral regurgitation, in cardiac dropsy and in cardiac dyspnoea, but 
that it can fully replace digitalis in the treatment of heart-affections 
is yet not fully established. As its action is more rapid than digi- 
talis, it may be prescribed when prompt results are required, and 
thus gain the time necessary for the influence of the digitalis to 
manifest itself. 

The sulphate is the salt usually preferred and may be given in 
doses of gr. ss-ij, t. d., in pill, capsule or solution. It is also used 
hypodermically. 

CIMICIFUGA. 

Cimicifuga racemosa, Black Snakeroot, or Cohosh {Nat. Ord. 
Ranunculacese), is a very common indigenous perennial plant, 
growing to the height of from four to eight feet, with ternate leaves, 
oblong-ovate, incised and toothed leaflets, and small white flowers 
disposed in a long raceme. The rhizome and rootlets are the 
parts employed. The rhizome is a rugged, blackish-brown caudex, 
from a third of an inch to an inch in thickness, often several inches 
in length, furnished with numerous slender rootlets. Internally its 
color is whitish ; it has a peculiar faint, disagreeable odor and a 
bitter, somewhat astringent, taste. It imparts its virtues to boiling 
water, and contains gum, starch, two resins, tannic, and gallic acids, 
and a volatile oil. The active principle has not yet been isolated, 
nor has a crystalline proximate substance been found.* 



* '' Lloyd's Drugs and Med. of North America," Vol. i, p. 266. 



286 



MATERIA ME DIC A AND THERAPEUTICS. 



Incompatibles. — As it contains tannic and gallic acids (q. v.), 
precipitates are formed with ferric salts. 

Aids. — Digitalis, strophanthus, and sparteine enhance its car- 
diac action ; ergot upon the uterus. 

Effects and Uses. — The effects of cimicifuga are not very 
accurately known. After large. doses, vertigo, dilated pupil, and 



FIG. 24. 




CIMICIFUGA RACEMOSA. 



often hypnotic and anodyne effects are seen. On the circulation its 
effects are similar to, but less powerful than, those of digitalis, as it 
slows the cardiac beat, while increasing the strength of its contrac- 
tion, and raising the arterial tension. It is undoubtedly an active 
stimulant of the secretions, particularly those of the skin, mucous 



SPINANTS—CONIUM. 287 

membranes and kidneys. It acts also on the uterus and unstriped 
muscles like ergot, but less powerfully. It increases the sexual 
appetite of the male and promotes the menstrual flow of the female. 
It has been prescribed with advantage as an expectorant in chronic 
bronchitis, and occasionally in caseous pneumonia and phthisis. In 
fatty heart it is safer than digitalis, and may be used in dilated heart, 
with languid circulation and oppressed breathing. It has also been 
used as a diaphoretic in rheumatism and as a diuretic in dropsies. 
As an antispasmodic in chorea it enjoys some reputation. In the 
relief of after-pains, and in Menorrhagia it is frequently of service, 
and it is a good remedy in subinvolution of the uterus. 

Administration. — Dose, in powder, gr. xx-5j. Of the fluid 
extract ox tincture the dose is f5ss-j or ij. 

DEPRESSO-MOTORS. 
CONIUM. 

Conium maculatum, or Hemlock (Nat. Ord. Umbelliferae), is a 
biennial European plant, naturalized in many parts of the United 
States. Its stem is erect, from three to five feet high. The leaves 
are large and bright green ; the flowers are small, white, and arranged 
in umbels. The whole plant is narcotic and virulent, and has a fetid, 
heavy odor. The full-grown fruit (gathered while yet green, and 
carefully dried) is the only portion used. It has a yellowish-gray 
color ; a feeble odor and a bitterish taste ; it is roundish ovate, a line 
and a half in length by a line in breadth, and striated. 

Chemical Constituents and Tests. — The active principle of 
hemlock is an alkaloid termed conine (C 8 H 15 N), which exists in larger 
proportion in the seed than in the leaves. It is a colorless, trans- 
parent, volatile, oily fluid, of a peculiar repulsive, suffocating, mouse- 
like odor and a bitterish taste, sparingly soluble in water, and freely 
so in alcohol, ether and chloroform, and undergoes decomposition 
upon exposure to the air. It is a highly energetic poison,' even in 
very small quantity ; the dose of it is gr. T \. Other alkaloids, termed 
conhydrine (C 8 H 17 NO) and methylconine (C 8 H 14 CH 3 N), have been 
isolated ; all probably exist as malates. Conine combines with acids 
to form salts, and unites with water as a hydrate. Tests. — Sul- 
phuric acid turns conine to purplish-red changing to green ; with 
perchloride of gold a yellowish-white precipitate is formed. 

Incompatibles. — Solutions of the alkalies liberate the alkaloid 



288 



MATERIA ME DIC A AND THERAPEUTICS. 



from its salts with the odor of hemlock. Tannic acid precipitates 
the alkaloid. 

Aids. — Depresso-motors as woorara, physostigma, tobacco and 
gelsemium. 

Physiological Effects. — The following account is based on 
the investigations of Lautenbach* (chiefly), and Hubert- Valleroux.f 
Local action : conine applied to a part produces paralysis of the 
end-organs of the sensory nerves with which it is brought in con- 
tact, and consequently numbness or loss of sensation. Nervous sys- 
tem : hemlock has but little influence upon the cerebral hemispheres, 




CONIUM MACULATUM. 

for in cases of poisoning from it, consciousness has been preserved to 
the last. ' A full medicinal dose induces the following effects : a 
sense of muscular fatigue and feebleness of the legs is felt, the eye- 
lids droop, and vision becomes impaired, accompanied by dilatation 
of the pupil. In lethal doses conium causes paralysis, which is due 
to a paralyzing influence on the terminal extremities of the motor- 



* Trans. Acad. Nat. Sci., Phila., 1875, P« 3^7 '< The Phys. action of hemlock and its 
alkaloid. 

f Arch. Gen. de Medecine 6 e ser. t. xvi, p. 83. De la cigue at son action phys. et therap. 



SPINANTS— CONIUM. 289 

nerves. It impairs the conductivity of the sensory nerves, while its 
action on the cord is one of progressive depression (Lautenbach). 
The circulation is at first accelerated, then retarded, but further in- 
vestigation is here required. The arterial pressure is at first lowered, 
and then decidedly raised ; the respiratory movements are not altered 
unless a poisonous dose has been taken, when the respiratory centre 
is paralyzed and death ensues from asphyxia. Temperature : some 
lowering of the animal heat has been noted ; but this, lately, has 
been denied by Lautenbach. Secretions : conium has no action on 
the glandular organs, except the salivary glands, the discharge from 
which it increases. Elimination : hemlock is eliminated in part by 
the urine, as it has been found there. Orfila detected it in the spleen, 
kidneys, and lungs. It has no direct hypnotic effect. Like woorara, 
its characteristic physiological effect is the production of pure motor 
paralysis, beginning in the extremities and extending to the trunk, 
involving chiefly the terminal nerve-endings. 

Toxicology and Antidotes. — In large doses it causes nausea, 
vertigo, dimness of vision, relaxation of the muscles ; and in poison- 
ous quantities, dilatation of the pupils, difficulty of speech, delirium 
or coma, paralysis, and finally convulsions (of cerebral origin) and 
death. In cases of poisoning, the stomach must be evacuated, and 
as physiological antidotes, the tetanizing agents, as strychnine and 
picrotoxin given, and alcoholic stimuli if necessary. 

Medicinal Uses. — It is employed as a general and topical ano- 
dyne, to relieve the pain of malignant tumors ; and, even if destitute 
of the deobstruent powers which have been ascribed to it, it certainly 
exerts a remarkably palliative influence upon painful chronic indura- 
tions. It has also been prescribed as an antispasmodic in whooping- 
cough, asthma, as a motor-depressant in paralysis agitans, chorea and 
acute mania, and as an anodyne in neuralgia; as an adjuvant to 
other remedies in melancholia; to moderate irritability of the sexual 
organs ; to relieve the blepharospasm of many acute inflammations 
of the eye ; and it is used externally as an anodyne-cataplasm to 
cancerous and irritable ulcers. Conium is quickly absorbed, and is 
eliminated with equal rapidity ; hence its effects are speedily induced, 
and are of brief duration. It is the cicuta of Hippocrates, Galen, 
and Pliny, and is supposed to have been the poison administered to 
Socrates and Phocion. 

Administration. — The dose of the powder, gr. ss-j. The 
extract [alcoholic) may be given in the same doses. An abstract is 
J 9 



290 MATERIA MEDICA AND THERAPEUTICS. 

also official; dose, gr. %-'). A ti?icture (dose f5ss-j) and a fluid ex- 
tract are also used ; of the fluid extract, in preparing which hydro- 
chloric acid is employed to fix the alkaloid conine, the dose is TTLiv-v, 
gradually increased until some effect is obtained. 

The preparations of conium are uncertain, from the fact that 
the active principle is very volatile and easily escapes. Probably 
the best preparation is the fluid extract. 

PHYSOSTIGMA. 

Physostigma or Calabar Bean is the seed of Physostigma 
venenosum (Nat. Ord. Leguminosae), a perennial climbing plant 
of the western coast of Africa. The seed is about .the size of a 
large horse-bean, irregularly kidney-form in shape, with a hard, 
brittle integument, and of a dark chocolate-brown color. The in- 
ner kernel is by far the more active portion. Alcohol, but not 
water, extracts its medicinal virtues. The Calabar bean has long 
been used among the negroes of western Africa as an ordeal to de- 
termine the guilt or innocence of accused individuals, whence its 
name, the ordeal bean of Calabar. 

Fig. 26. 




CALABAR BEAN. 

Chemical Constituents. — It yields an active alkaloid, termed 
eserine or physostigmine (Q5H21N3O2) sparingly soluble in water, but 
more soluble in alcohol, ether, and chloroform; and recently an- 
other alkaloid, termed calabarine, which is believed to be a tetaniz- 
ing agent, has been found in it in variable amount. 

Incompatibles. — The alkalies and tannic acid. 

Aids. — -The motor-depressants, as conium, gelsemium, woo- 
rara, tobacco, etc. 

Physiological Effects. — The local application of a strong 
solution abolishes the functions of both kinds of nerves (Fraser).* 

* For an elaborate account of the action of Calabar bes.n, consult Dr. T. R. Fraser's 
Thesis, 1863. 



SPINANTS—PHYSOSTIGMA . 291 

It has been found, in full medicinal doses, to produce giddiness, 
torpor, paleness and coolness of the surface, weak and irregular 
pulse, relaxation of the muscular system, and drowsiness, but not 
stupor. An interesting effect of its action is a remarkable power 
of contracting the pupil, whether taken internally or applied ex- 
ternally : it seems probable that this is accomplished by a local 
peripheral action — i. e., paralysis of the sympathetic terminals and 
stimulation of the oculo-motor fibres in the iris; and it also con- 
tracts the ciliary muscle, which regulates the accommodating power 
of the eye. 

Nervous system : the brain is not directly affected by Calabar 
bean, the paralysis induced by it being due to a depressing action 
upon the spinal cord. In proof of this statement can be offered 
the fact that the muscular contractility and irritability of the 
motor and sensibility of the sensory nerves remains unimpaired in 
cases of poisoning by physostigma. Lethal doses of physostigma 
cause total loss of reflex activity in the cord. Circulation : small 
doses of physostigma retard the heart's action by lengthening the 
diastolic pause, while toxic doses arrest it in diastole, but before 
the movements are extinguished there is a marked fall in blood- 
pressure. The stoppage is probably due to paralysis of the cardiac 
ganglia. Respiration : toxic doses of physostigma cause slowing 
of these movements, and eventually they are abolished, death en- 
suing from asphyxia. It is allied in its effects to woorara and 
conium, but differs from them in its tendency to produce muscular 
twitchings and contraction of the pupil. Intestines : Calabar bean 
increases decidedly intestinal peristalsis. Augmentation of the 
salivary secretion has been observed. 

Toxicology and Antidotes. — A poisonous dose of physo- 
stigma in man causes nausea, giddiness, muscular weakness and 
tremors, diminished cardiac action, abolition of reflex action, slow 
respiration, myosis and motor-paralysis. In cases of poisoning, 
after emptying the stomach, the hypodermic administration of a 
solution of atropine is the best physiological antidote. Chloral 
mitigates the symptoms, and the tetanizers may render service. 

Medicinal Uses. — Calabar bean has been found highly effica- 
cious, from its power of reducing and abolishing the reflex activity 
of the cord, in traumatic tetanus, but it must be given in doses 
large enough to attain decided effects. Fraser advises the exhibi- 
tion of eserine hypodermically in severe cases. It has been used 



292 MATERIA MEDICA AND THERAPEUTICS. 

also with success as a motor-depressant in paralysis agitans and in 
chorea; likewise in poisoning from strychnine. In ophthalmic 
surgery its employment is obvious, either to produce contraction of 
the pupil or to increase the power of accommodating the eye to 
distances. 

Administration. — The dose of the kernel is laid down as gr. 
ij-iij, to begin with, gradually increased. By exhausting the kernel 
with alcohol, and subsequent evaporation, an extract is obtained, of 
which the dose is gr. }i. A good form of exhibition is the tincture 
( i oo parts contain 10 parts of powder), dose, Tltv-xv; or a solu- 
tion in glycerin may be used. Eserine itself, or as a salt, one part 
to a thousand in solution, may be applied to the eye* in- ophthalmic 
practice, as to contract the pupil in photophobia, to lessen intra- 
ocular tension early in glaucoma and in keratitis; dose, internally, 
gr. fo-tt. PhysostigmincE salicylas is official. It is the most stable 
salt of the alkaloid, but its slight solubility in water renders it of 
little value for hypodermic injection. Dose, gr. -h~h (Stille and 
Maisch). Gelatin-disks are now much used by oculists. 

CHLORAL. 

This interesting compound, although discovered by Liebig in 
1832, has attracted attention as a therapeutic agent only since the 
statements of Liebreich, a physician of Prussia, published in May, 
1869. 

Preparation. — It is prepared by passing dried chlorine gas 
through pure anhydrous alcohol, afterward gently heating, when the 
liquid separates into two layers, the lower of which is chloral; this is 
agitated with sulphuric acid, and purified by distillation, first over 
sulphuric acid and then over quicklime ; the reaction, upon which 
the formation of chloral depends, in this process, is complicated, 
chloral and hydrochloric acids being the chief products. Anhydrous 
chloral (C 2 HC1 3 0) is a thin, limpid, oily, colorless liquid, greasy to 
the touch, with a fatty taste, and a strong pungent smell, producing 
lachrymation. Chemically, it is classed with the halogen aldehydes. 
It has a sp. gr. of 1.502, a boiling point of 203 F., and mixes in 
all proportions with water, alcohol, ether and chloroform. 

Chemistry and Tests. — Mixed with one- eighth its weight 
of distilled water, it combines to form the so-called hydrate 
(C 2 HC1 3 0.H 2 0), for it contains an entire molecule of water, which 
crystallizes in a mass of snow-white needles, soluble in their own 



SPINA NTS— CHL ORAL. 293 

weight of water; and, as pure chloral readily undergoes decom- 
position, the more stable hydrate is the form which is employed for 
medicinal use. Tests. — Pure chloral hydrate* when pressed be- 
tween blotting-paper does not leave oily spots ; its taste is bitter 
and somewhat astringent; makes a neutral solution with water 
without forming oily drops; is not decomposed by the action of the 
atmosphere ; dissolves readily in water, ether, and alcohol ; the 
aqueous solution acidulated with HN0 3 affords no evidence of 
chlorine when treated with AgN0 3 . The chloroformic solution 
yields no change of color when agitated with H 2 S0 4 . 

Chloral combines also with alcohol, forming a compound 
termed Chloral Alcoholate, which resembles the hydrate, but is 
less soluble in water, and is said by Liebreich to be therapeutically 
inert. 

Incompatibles. — The volatile and fixed alkalies, and calcic 
hydrate, convert chloral into formate of the metal and chloroform. 

Aids. — Morphia, the bromides, and sleep-producing agents 
enhance its hypnotic effects ; upon the spinal cord, conium, physos- 
tigma, woorara, etc. 

Physiological Effects. — Chloral has decided antiseptic pro- 
perties, destroying low organisms and preventing the decomposition 
which they induce, as pointed out by Keen ;f and it is also an 
irritant. Its taste is bitter, astringent and somewhat caustic. Ner- 
vous system: in doses of 20 grains, chloral is a most reliable 
hypnotic, the sleep being usually, quiet, natural, and refreshing.^ 
Generally, no unpleasant effects follow its employment, though 
occasionally headache and slight nausea supervene. According to 
Hammond, chloral causes cerebral anemia, the brain being in this 
condition when chloral-sleep sets in. In medicinal doses, it is not 
a pain-relieving agent in the way that opium is. In hypnotic doses 
it slightly contracts the pupil. 

Da Costa§ states that it has no special action on the secretions, 
except some augmentation of the urine, and is probably elimina- 
ted by the kidneys. When larger amounts are given, the sleep 
is deeper, and may pass into coma ; the respiration is slower ; 



* Attfield's " Chemistry,'' 10th ed., p. 444. 

f Amer. Jour. Med. Set., July, 1875. 

X Bull. Gen. de Therap., LXXVII, p. 307, Demarquay. 

§ Am. your. Med. Sci., April, 1870, p. 309. Clinical notes on chloral. 



294 MATERIA MEDICA AND THERAPEUTICS. 

the pulse is reduced in fullness and frequency, the arterial ten- 
sion being lowered; the temperature falls; the muscular system 
is relaxed; and both sensibility and reflex action are abolished, 
the latter being brought about by a direct action on the spinal 
cord, since chloral does not affect the motor-nerves nor mus- 
cular contractility. Ringer * found that it affected the cardiac 
tissues directly and ultimately stopped the heart in diastole, the 
contractility of the muscle-substance being extinguished by it, 
though Brunton states it paralyzes the cardiac ganglia. It was 
formerly asserted that chloral is decomposed in the blood by 
the liberation of chloroform ; but this is not the case, as Amoryf 
has proved, for no chloroform could be detected in the breath or 
blood of a dog poisoned by chloral, but on introducing chloroform 
by enemas this drug was found in the blood and respired air at 
once 

Toxicology. — Large amounts may be taken without fatal re- 
sults, as 460 grains have been given without unpleasant effects, 
though gr. xx, in three cases, proved "poisonous, and gr. xxx killed 
an adult female. % The symptoms of poisoning are profound 
sleep, diminished frequency of the respiration and circulation, red- 
ness of the conjunctivae, contraction of the pupils, lividity of the 
lips, and falling of the jaw, with occasionl eruptions of the skin. 
Death takes place probably from sudden failure of the heart's 
action, which stops in diastole, or from paralysis of the respiratory 
centre. 

Antidotes. — The treatment of chloral-poisoning is much the 
same as that pursued in opium-poisoning; artificial respiration 
should always be resorted to before the respirations cease. Strych- 
nine has been recommended to prevent cardiac failure, but accord- 
ing to Dr. Kobert, while chloral is the best antidote for poisoning 
by strychnine, their antagonism is not reciprocal, as the latter 
neither prevents the respiratory arrest, nor counteracts the depress- 
ing effect of chloral on the heart, nor prevents the lowering of the 
bodily heat. Atropine is probably the best antidote in cases of 
chloral-poisoning; it should be given frequently, guided by the res- 



* Brit. Med. Jour., March 10th, 1883. Experimental investigation on the action of 
chloral, etc. 

f N. Y. Med. Journ., XV, 1872, 606 ; also Journal de V Anatomie et de la Physiologie, 
1870-71, p. 570. 

% The Lancet, March 25th, 1871, 403. 



SPINA NTS- CHL ORAL. 295 

piration, and the temperature of the body should be maintained by 
the application of dry heat. 

Medicinal Uses. — Chloral is a most valuable hypnotic remedy 
in all the forms of insomnia, in hysterical excitement, in acute mania, 
mama a potu, and in delirium tremens. As an antispasmodic, large 
doses are required. It has been used with advantage in infantile 
convulsions, and even in puerperal and uremic convulsions, both by the 
mouth and hypodermically, and it is especially recommended in the 
relief of rigid os during labor. In sea-sickness it is highly recom- 
mended, though nothing is of much service in this complaint. In 
tetanus, in order to lessen the spinal reflex activity, much success 
has been obtained with chloral, in ten-grain doses every two hours ; 
and the same remedy may be given to alleviate the paroxysms of 
spasm of hydrophobia. In whooping-cough and chorea, it has also 
been employed with advantage, and as an antidote against strychnine. 
As an anodyne it is available, but only in narcotic amounts. The 
ordinary dose of chloral is 20 grains, which may be safely repeated 
every hour or two, till three doses have been taken or sleep occurs. 
An equal weight of chloral hydrate added to powdered camphor 
makes a valuable local anaesthetic liquid. 

Administration. — Chloral is given only in aqueous solution, 
and the addition of mucilage or syrup, particularly of the syrup of 
orange-peel, will disguise its unpleasant taste. It is not well adapted 
to the hypodermic method, as painful phlegmons sometimes follow 
its repeated use. Locally, in dilution (gr. x to fSj of water), or as 
an ointment (5ss to §j), it is a good stimulant and deodorizing ap- 
plication to foul and fetid indolent ulcers; as an injection in gonor- 
rhoea (gr. xx to f§j of water), it answers well; and injected into 
subjects for the dissecting room (Keen, loc. cit. ), and in the preser- 
vation of anatomical preparations, it has been also found useful (gr. 
xl to foj of water). 

Croton- Chloral Hydrate (more correctly termed butyl-chloral 
hydrate) (C 4 H 5 C1 3 0.H 2 0) is made by the action of chlorine upon 
ethylic aldehyde,, and, when pure, occurs in beautiful white, silvery 
crystals, with a sweetish melon-flavor, only slightly soluble in water. 
Its action is similar to chloral, though thought to be feebler ; in ad- 
dition it causes anaesthesia of the head. It is useful as an anodyne 
in neuralgia of the trigeminal, and also in chronic cough, in doses 
of from gr. xv-xx, dissolved in glycerin and syrup. 



296 MATERIA MEDICA AND THERAPEUTICS. 



POTASSII BROMIDUM— POTASSIUM BROMIDE. 

Preparation and Test. — Potassium bromide (KBr) is prepared 
by adding a solution of pure potassium carbonate to a solution of 
ferrous bromide. The iron is precipitated, and the potassium bro- 
mide remains in solution, from which it is obtained by evaporation. 
It occurs as a permanent, colorless, anhydrous, crystalline salt, of a 
pungent, saline taste, very soluble in water, and slightly so in alcohol. 
When mixed with starch, a yellow color is developed on the addi- 
tion of chlorine. A bluish tint shows the presence of an iodide. 

Incompatibles. — Acids, acidulous, and metallic salts decom- 
pose potassium bromide; with the alkaloids bromides are formed. 

Aids. — Its action on the brain is enhanced by opium, chloral, 
cannabis Indica and similar agents; its depressing effects on the cir- 
culation by aconite, gelsemium, veratrum viride, etc. 

Physiological Effects. — The statement of the action of po- 
tassium bromide is based on the investigations of Amory,* Bill, "f" 
Nuneley,J Bartholow, § Lasegue, || Damourette et Pelvet. If Local 
action : when applied to the pharyngeal mucous membrane, it is 
said to lessen the reflex irritability of the part. Nervous system : 
when brought in contact with the motor-nerves and spinal centres 
of the frog, potassium bromide destroys their functions. This 
action, however, is probably due to the potassium which it contains 
(Ringer), and is shared by the other potassium salts. 

When administered internally (to animals), the irritability 
of the brain is decreased, owing in great part to the anemia 
caused by the action of the drug upon the vaso-motor nerves which 
govern the calibre of the vessels. Reflex irritability is diminished, 
partly on account of the paralyzing influence exerted on the reflex 
functions of the cord, and in part from paralysis of the end-organs of 
the peripheral nerves ; on the latter account, also, cutaneous sensi- 
bility is lessened. It possesses a sedative action on the sympathetic 
system, giving rise to diminished cardiac action, decrease in the 



* Pamphlet, 1869. " Exper. upon the Phys. Action of Bromide of Potassium, etc." 
■\Am. y. Med. Set., July, 1868. 
J The Practitioner, III, 347. 

g Pamphlet, 16 pp. " Exp. Investigation into the Actions and Uses of the Bromide ol 
Potassium." 

|| Arch. Gen. de Medecine, t. VI. 6ieme ser., p. 81. 
% Bull. Gen. de Therap., LXXIII, pp. 241, 289. 



SPINA NTS— POTASSIUM BROMIDE. 297 

supply of blood to various organs, and slight reduction in the tem- 
perature of the body. 

Circulation : topically applied to the heart (and voluntary 
muscles), it destroys their functions, as in the case of the topical 
application to the nervous centres, and probably for the same 
reason. In very large doses it lessens the frequency and force 
of the cardiac contractions, shortening the systole, prolonging 
the diastole, and, finally, paralyzing the heart in diastole. The ten- 
sion of the arterial system is lowered. Respiration: it slows respi- 
ration and causes death by arrest of the respiratory centres (Ott). 
Temperature : in warm-blooded animals, toxic doses lower very de- 
cidedly the temperature, probably owing to a direct checking of 
tissue-changes. Secretion : at first the secretions and excretions are 
diminished, but, later, they are increased in amount. If a very large 
dose is taken, they are increased primarily. No lachrymation, sali- 
vation, or catarrh is produced, as after the administration of the io- 
dides. After large doses, micturition is less frequent, because the 
vesical irritability is lessened, — not because the amount of urine 
is decreased. A very large dose may paralyze the sphincter and 
produce incontinence of urine. The amount of urea eliminated is 
diminished as is, also, the quantity of carbonic acid exhaled from the 
lungs, and the perspiration is decreased. 

In man, the action of the bromides is similar to the action in 
animals ; the cerebral symptoms being, however, more marked, 
because of the greater development of the hemispheres. Their taste 
is saline and disagreeable. When long continued, potassium bromide 
exerts a very marked depressing effect upon the sexual functions, en- 
feebling their vigor, and diminishing the sexual appetite. But these 
symptoms pass away when the drug is withheld. When considera- 
ble doses are given for a long period, a train of symptoms is pro- 
duced to which the name bromism is applied. These are mental 
weakness, great drowsiness, failure of memory, anemia, malnutrition 
and depression of spirits, with often, impaired sensibility of the 
mucous and cutanous surfaces, diminution of the sexual functions, 
and an eruption of the skin (generally on the face and back), usually 
of acne, which rarely suppurates, occasionally of eczema, and, very 
rarely, rupial ulcers may be seen. Elimination : potassium bromide is 
eliminated chiefly by the kidneys; but also by the mucous mem- 
branes of the fauces, intestinal canal and bronchi, by the skin, and 
by the salivary glands. It is absorbed by the blood rapidly (Earth- 



298 MATERIA MEDIC A AND THERAPELTICS. 

olow, loc. cit.) as traces may be found in the urine ten minutes 
after its administration, but elimination is slow. According to 
Amory (loc. cit.), it passes out, when given in medicinal doses, 
undecomposed, by the skin and kidneys. No case of acute poison- 
ing by potassium bromide has been reported. 

Medicinal Uses. — From its action on the nervous system, 
potassium bromide is much used to quiet cerebral excitement and 
for its sedative effect on the reflex centres of the cord. And for this 
purpose it is of great value in meningitis, cerebral or spinal, to allay 
irritation and hinder convulsions. 

As a narcotic (by causing anemia of the brain), it is much 
used in insomnia due to cerebral hyperemia, or even when not more 
than the normal amount of blood is sent to the brain ; in wakeful- 
ness and wandering during convalescence from acute diseases ; and 
in sleepessness due to worry, grief, dyspepsia, and over-work; also 
in cases of night-horror, in children, where they awake suddenly 
and scream with fright, often for a considerable time, small doses 
of this salt and a light supper will frequently effect a cure ; adults 
subject to nightmare will find relief, too, in the temporary use of 
potassium bromide ; to allay restlessness, remove delusions, calm 
delirium, and produce sleep in the early stages of delerium tremens 
and in mania-a-potu, it is given in doses of gr. xx to xxx every two 
hours until sleep is produced. It is more efficient in the early 
stages, and can be relied on with more certainty in the first than in 
subsequent attacks. 

For the relief of uncomplicated vertigo it is of service, and it is 
one of the remedies used for laryngismus stridulus, and during the 
paroxysmal stage of whooping-cough. It may be prescribed also to 
stop obstinate hiccough and spasmodic pharyngeal cough. 

In those functional cardiac affections in which excited or ir- 
regular action is a prominent symptom, as irritable or over-acting 
heart, or in palpitation, the bromides by lessening the frequency 
and force of the contractions, render important service. In the last 
two conditions aconite is a valuable adjuvant. 

Potassium bromide is often combined with other narcotics, as 
opium, chloral, etc., to aid their action, and even to modify their 
disagreeable effects. It will generally prove beneficial in women 
suffering from nervousness ; great despondency, amounting to a 
feeling of approaching madness; irritability; lack of interest in 
their surroundings ; sleeplessness and harassing dreams, caused 



SPINA NTS— POTASSIUM BROMIDE. 299 

by overwork, want of change, grief, or worry. If the medicine 
does not succeed alone, it will when combined with a change of 
scene. In some cases of hysteria, potassium bromide is a valuable 
remedy. In all forms of convulsions (epilepsy, chorea, convulsions 
of Bright's disease, convulsions of children, etc.) it will prove ben- 
eficial, by diminishing the reflex function of the cord. 

In epilepsy the bromides are preeminently of service, lessening 
the frequency of the attacks, if not absolutely preventing their re- 
currence. It is stated by Trousseau that they are less efficient in 
attacks of petit mal than in those of severer form; but Dr. A. 
Hughes -Bennett has recently published a number of cases of the 
lighter variety, in the majority of which the bromides proved suc- 
cessful. They should be given in doses sufficient to prevent reflex 
retching or nausea, when the fauces are tickled (Voisin), and must 
be continued for years, with an occasional intermission of a week 
or two. 

Potassium bromide has been successfully used in the treat- 
ment of strychnine- poisoning ; it should be given in doses of 5ij, 
frequently repeated, as the case may require. It has also been 
successfully used in tetanus. It has been recommended during 
dentition, to allay irritability and restlessness and to prevent con- 
vulsions. It is administered for the relief of the convulsions of 
uremia, and the puerperal state. In the reflex forms of vomiting, as 
the vomiting of pregnancy, of sea-sickness, and in migj'aine or sick 
headache (especially in the congestive forms), it is sometimes bene- 
ficial. In the colic of infants, unaccompanied by diarrhoea, it is an 
excellent remedy, relieving pain and spasm, and producing sleep. 
It is used, too, in large doses, 5j or more, to obtund the sensibility 
of the fauces, before the exhibition of the laryngoscope, but this is 
going out of fashion since the introduction of cocaine. 

From its sedative influence on the organs of generation, it is 
used with success in nymphomania, spermatorrhoea, masturbation, 
and chordee. In the last affection it may be taken in large doses 
throughout the day, the final one before retiring. It decreases the 
flow of blood in menorrhagia. The flushes of heat, followed by 
sweating and prostration, occuring at the menopause, are generally 
cured by the use of potassium bromide. 

Administration. — Dose, gr. v-5j or more. In epilepsy it is 
given in doses of gr. xx-xxx, thrice daily, and continued for a long 
period, with occasional intervals of a week or two. If bromism 



300 MATERIA MEDICA AND THERAPEUTICS. 

occur, stop the remedy for the time, and give tonics. The bromide 
rashes are easily cured by withdrawing the medicine, and giving 
liquor potassii arsenitis internally in small doses, and the local use 
of an ointment containing iodide of sulphur. Potassium bromide 
should be administered in solution, aud preferably between meals. 
It may be disguised with simple elixir. 

AMMONII BROMIDUM— AMMONIUM BROMIDE. 

Preparation. — Ammonium bromide (NH 4 Br) is prepared by 
mixing bromine with iron-wire in distilled water, agitating the mix- 
ture until the liquid assumes a greenish color, and then adding 
water of ammonia to the mixture, which precipitates the iron as 
ferrous hydrate, ammonium bromide remaining in solution. By 
filtration and evaporation, a white, granular salt is obtained, which, 
on exposure to the air, gradually becomes yellowish (in conse- 
quence of the liberation of hydrobromic acid), has a saline, pungent 
taste, is very soluble in water, and moderately so in alcohol. 

Incompatibles and Aids. — See potassium bromide. 

Physiological Effects. — The action of ammonium bromide 
resembles ', in many respects, that of the potassium salt. When ap- 
plied locally to the motor nerves, spinal centres, heart, or volun- 
tary muscles, it does not destroy their functions, and has less influ- 
ence, when administered internally, on the circulation, respiration 
and temperature. 

Medicinal Uses. — It has been used for the same conditions in 
which potassium bromide is given. Echeverrhia prefers the am- 
monium bromide in epileptic maniacal excitement, but states that it 
will fail unless combined with chloral, cannabis Indica, or other 
narcotic, or better still, with ergot. The combined use of ammon- 
ium and potassium bromide has been recommended by Brown- 
Sequard. Da Costa highly recommends its use in acute rheumatism. 
It has also been given with advantage in whooping-cough. 

Administration. — It is given in doses of gr. v-xxx, thrice 
daily, and is best administered in some bitter infusion, or simple elixir. 

Sodii Bromidum {Sodium Bromide) (NaBr) may be prepared in 
a similar manner to potassium bromide. 

In its physiological effects it resembles potassium bromide, but 
is much feebler. 

It is used in the same diseases and in the same doses as is the 
potassium salt. 



SPINA NTS— TOBA CCO. 301 

Lithii Bromidum ( Lithium Bromide) (LiBr)has been recommended 
as the most efficacious of the bromides. S. Weir Mitchell has 
found it efficient in gr. x-xx doses, in some cases of epilepsy, after 
the potassium bromide had failed. It has been used in gout, but 
not with much success. It contains a larger per cent, of bromine 
than do the other salts, and is very soluble. 

Caicii Bromidum (Calcium Bromide) (CaBr 2 ) has been employed 
for the same purposes and in the same doses as potassium bromide. 

Zinci Bromidum [Zinc Bromide) (ZnBr 2 ) has been prescribed in 
the treatment of epilepsy, but its use is not general. Hammond * 
has obtained beneficial results with the salt in arresting the epileptic 
paroxysms where the other bromides had failed, and it has the ad- 
vantage of not causing bromism or a cutaneous eruption. Dose, 
gr. ij-xx, in syrup and water. 

Recently strontium bromide has been introduced. It is stated 
not to cause the bromide eruptions, or disorder of the stomach ; 
recommended in gastralgia and dyspepsia, with pain. Dose, gr. 
x-xxx, in syrup and water. 

Acidum Hydrobromicum Dilutum (Diluted Hydrobromic Acid) is 
a clear, colorless liquid, without odor, but having a strongly acid 
taste, which consists of 10 per cent, of absolute hydrobromic acid 
(HBr), and 90 per cent, of water. It has a sp. gr. of 1.077. 

Effects and Uses.— This acid does not differ materially in its 
action from potassium bromide, and has been used as a substitute 
for it in epilepsy, alcoholism, congestive headache, vertigo, chorea, in- 
somnia, hysteria, etc. It has been recommended to combine it with 
quinine as a preventive of cinchonism. Its value does not seem to 
be very firmly established. Dose of the diluted acid, f5ss-ij. 

TABACUM— TOBACCO. 

Nicotiana Tabacum, or Virginia Tobacco (Nat. Ord. Solanaceae), 
is a native of the warm countries of America. It is an annual plant, 
growing to the height of from three to six feet, with large oblong, 
pointed, hairy, pale-green leaves, and light-greenish, funnel-shaped 
flowers. The dried leaves are the portion used. They have a 
yellowish-brown color, a strong, peculiar, narcotic odor, and a bitter, 
nauseous taste. The darker-colored leaves are the strongest. 

Chemical Constituents and Test. — The virtues of tobacco 
are imparted to alcohol and water, and depend on the presence of 

*" A Treatise on Diseases of the Nervous System," 1888, p. 716. 



302 MATERIA MEDIC A AND THERAPEUTICS. 

an alkaloid called nicotine (C 10 H 14 N 2 ) (as a malate), which is found 
in all parts of the plant, but not in tobacco-smoke. It is a colorless, 
oily, volatilizable, alkaline liquid, highly soluble in water, alcohol, 
ether, chloroform, the fixed oils, and oil of turpentine, of a feeble 

Fig. 27. 




TOBACCO. 



odor when cold, but irritant when heated, of an acrid, burning taste, 
and is a most energetic poison, ranking after prussic acid. From 
the dried leaves are also obtained a concrete volatile oil, termed 
nicotianin, which is probably the odorous principle of the plant, and 
an cmpyreumatic oil, which gives the peculiar smell to old tobacco- 



SJ '/NA Ar/S— TOE A CCO. 303 

pipes. Both of these principles are poisonous. Tobacco-smoke * 
has been found "to contain numerous basic substances of the pico- 
linic series, and ceded to caustic potash, hydrocyanic acid, sulphur- 
etted hydrogen," with fatty acids, phenol and creasote. Test. — 
Nicotine is thrown down from aqueous solution as a yellowish- 
white precipitate by platinum perchloride. 

Incompatibles. — Tannic acid and the caustic alkalies. 

Aids. — The depresso-motors, as physostigma, woorara, etc. 

Physiological Effects. — Local action : applied to the skin 
tobacco is readily absorbed. On persons unaccustomed to its use, 
tobacco, in small doses, produces nausea, depression, and a feeling 
of wretchedness. Nervous system : tobacco expends its action on 
the spinal cord, and not upon the brain, and nicotine, in full doses, 
acts as a tetanizing agent on man. Nicotine contracts the pupil 
either locally or internally. The conductivity of the motor nerves 
is more or less abolished, and lastly that of the spinal cord, while 
the voluntary muscles remain unaffected. These remarks apply to 
lethal doses of the drug. Circulation : the red globules of the 
blood of a person under the influence of tobacco present a crenated 
appearance. Tobacco is not a cardiac poison, since the application 
of nicotine to the cut-out heart will not stop its beats ; nevertheless 
it slows the cardiac action and temporarily reduces the blood-pres- 
sure. Intestines : tobacco has a relaxing influence upon this tract, 
and the injection of nicotine induces intestinal peristalsis. Nicotine 
is probably eliminated by the kidneys. 

The habitual use of tobacco-smoke as an exhilarant is well 
known. When taken to excess, it frequently develops maladies of 
the stomach, heart, nervous system, and upper air-passages. Under 
its immoderate use such cardiac phenomena as overaction and pal- 
pitation are likely to ensue, and the use of tobacco is contraindi- 
cated when these conditions exist. Tobacco smoking is least 
injurious when not inhaled. 

Toxicology and Antidotes. — In lethal doses, it induces vomit- 
ing and purging, a sensation of sinking at the pit of the stomach, 
giddiness, disorder of vision, contraction of the pupils, depression of 
the circulation, great relaxation of the muscular system, coldness of 
the surface, and other symptoms of prostration ; and, when exces- 
sive doses have been taken, these symptoms become more violent, 

* Pharmacographia," 2d ed., p. 468. 



304 MATERIA MEDICA AND THERAPEUTICS. 

and are followed by clonic convulsions, paralysis and death. Wood- 
man and Tidy* have collected a number of fatal cases from the use 
of the infusion of tobacco by clyster and injection, so that it is a 
remedy, even locally, to be employed with caution. Cases of poi- 
soning are to be treated with the diffusible stimuli, after washing 
out the stomach, and strychnine is to be used hypodermically; dry 
heat should also be applied, and, if these means fail, artificial respir- 
ation should be resorted to. 

Medicinal Uses. — Tobacco is employed in medicine chiefly 
with a view to its action on the muscular system — its anodyne 
properties being relatively feeble. In various spasmodic diseases, 
particularly in colic, strangulated hernia, tetanus and asthma, it was 
formerly considered a remedy of great value, but more efficacious 
ones have superseded it. Tobacco is to be employed with caution, 
as it occasionally acts with dangerous energy. It is now rarely 
used medicinally. 

Administration. — Tobacco is not given by the stomach, owing 
to its emetic properties. It is usually administered by the rectum, 
in the form of infusion, or tobacco-smoke may be introduced into 
the rectum. It may also be smoked for medicinal effect, or applied 
locally in the form of cataplasm. The oil is sometimes mixed with 
ointments. 

LOBELIA. 

Lobelia inflata, or Indian tobacco (Nat. Ord. Lobeliaceae), is a 
very common annual or biennial indigenous plant, growing to the 
height of from six inches to two feet, having an erect, hairy stem, 
ovate, serrated leaves, pale-blue flowers, and ovoid, inflated capsules. 
All parts of it are active, but the leaves and tops only are official. 

Chemical Constituents. — Water and alcohol extract the 
virtues of lobelia, which contains a partly volatile alkaloid, lobeline, 
lobelic acid, fixed and volatile oil, gum, chlorophyll, etc. Lloyd f 
regards the alkaloid as a fixed one ; he also isolated a substance 
termed inflatin. Lobeline is a yellowish liquid, lighter than water, 
of an aromatic odor, an acrid taste, soluble in water, but more so 
in alcohol and ether. 

Incompatibles. — The caustic alkalies decompose lobeline. 

Aids. — The depresso-motors. 



*" Forensic Medicine, etc.," 1882, p. 381. 

f " Drugs and Medicines of North America," Vol. II, p. 75. 



SPINA NTS— L OBELIA. 



305 



Physiological Effects. — Lobelia produces effects on the 
system analogous to those of tobacco, acting in small doses as a 
sedative, nauseant and diaphoretic. According to Ott's * investiga- 
tions the alkaloid produced in the rabbit curious alterations of 
blood-pressure, viz. : first a fall, followed generally by a rise, and 

Fig. 28. 




LOBELIA INFLATA. 



lastly a very decided fall ; also slower respiration, paralysis, reduc- 
tion of temperature, and death from asphyxia. Lobelia, like tobacco, 
retards the heart's action, is said to increase the urinary flow, and, 
in an unexplained way, relieves bronchial spasm. Complete in- 



Boston Med. and Surg. Jour., 1875. 



20 



306 MATERIA MEDICA AND THERAPEUTICS. 

vestigations of its action have not yet been made. There are on 
record numerous cases of death from lethal amounts of lobelia. In 
large doses it is an energetic emetic ; and in still larger doses de- 
stroys life by paralyzing the respiratory centre in the medulla 
oblongata, the pupil being contracted. The peculiar depressing 
effects excited by lobelia upon the circulatory apparatus may be 
counteracted in a measure by the cardiac excitants as ether, alcohol, 
ammonia and strychnia. It was employed by the aborigines, and 
has always been a popular empirical remedy. 

Medicinal Uses. — Lobelia is sometimes classed among emetics, 
but its action in this particular is too violent for its safe adminis- 
tration. It is chiefly employed, by regular practitioners; in virtue 
of its bronchial antispasmodic properties for the relief of asthma, 
angina pectoris, and cardiac dyspnoea, and it is given in small doses, 
gradually increased until headache or nausea ensues. In asthma, 
Ringer advises lobelia to be given in large doses, viz., f5j of the 
tincture every hour, or even every half-hour. The chief draw-back 
to its use is its uncertainty and the nausea and depression induced 
by it. In asthma it possesses no curative power, seeming to be 
beneficial by reason of its antispasmodic and expectorant properties. 
It may also be used as an enema, to fulfill the same indications as 
tobacco. 

Administration. — Lobelia is given in substance, tincture, and 
infusion. The dose of the powder as an antispasmodic is gr. j-iij ; 
as an emetic, gr. v-xx. The best form, particularly in asthma, is 
the tincture (20 per cent., in diluted alcohol), which may be given in 
the quanity of f5ss-j, to be repeated as occasion may require. A 
fluid extract is also official ; dose tnj-xxx. 

Acetum Lobeliee ( Vinegar of Lobelia), made with diluted acetic 
acid, is a good preparation, in which the alkaloid is fixed by the 
acetic acid ; it contains 10 per cent, of lobelia. Dose, as an expect- 
orant, f5ss-j ; as an antispasmodic and nauseant, f5j-ij. 

ACIDUM HYDROCYANICUM DILUTUM DILUTED HYDROCYANIC ACID. 

Hydrocyanic acid, known also as cyanhydric acid and prussic 
acid, is derived from a variety of vegetable substances, as the bitter 
almond, peach-kernels and leaves, wild cherry, cherry-laurel, etc. 
It is employed in medicine only in a state of extreme dilution; and 
the diluted acid is obtained by the action of sulphuric acid and 



SPINA NTS— DILUTED HYDROCYANIC ACID. 307 

water on potassium ferrocyanide, or when wanted for immediate use, 
by the action of hydrochloric acid and water on silver cyanide. 

Chemistry and Tests. — Diluted hydrocyanic acid is a colorless, 
volatile liquid, with a peculiar odor and a cooling, somewhat 
irritating taste. It undergoes decomposition if exposed to the 
light, and should be kept in bottles covered with black paint or 
paper ; but it is not a stable preparation. It contains two per cent, 
of the anhydrous or concentrated acid. 

The anhydrous acid (HCy or HNC) is a colorless, feebly acid, 
transparent, very volatile and decomposable liquid, with a powerful, 
peculiar odor, and a cooling, afterward burning taste. Both water 
and alcohol dissolve it readily. Tests. — Its "presence in a suspected 
mixture may be detected by the addition of a solution of silver 
nitrate, which throws down a white, curdy precipitate of silver cyan- 
ide, distinguishable by its giving off, when dried and heated in a 
test tube, cyanogen gas which burns with a rose-colored flame (the 
silver test is the most delicate, when applied to prussic acid in the 
state of vapor); or, by adding to the suspected solution a little liquor 
potassae, and then a mixed solution of ferrous and ferric sulphate, 
a dirty greenish-blue precipitate is thrown down, which, on the 
addition of a few drops of pure hydrochloric acid becomes Prussian 
blue (the best liquid test). 

Incompatibles. — The metallic salts. 

Physiological Effects. — Locally: hydrocyanic acid applied 
directly to the skin exerts a benumbing influence, and may be 
absorbed with the aid of friction ; to a mucous membrane or wound 
it is readily taken up. Nervous system : in small doses it produces 
no symptoms beyond a calming effect. Full doses cause giddiness, 
confusion of mind, and muscular feebleness. Whether large doses 
act on brain, vagus, or peripheral nerves is disputed. The convul- 
sions which it produces are cerebral, for they do not occur in parts 
cut off from the cord. In the frog, Kolliker* finds that the direct 
application of hydrocyanic acid paralyzes the motor-nerve trunks, 
and destroys the irritability of muscle, and upon the peripheral 
sensory nerves acts as a paralyzant. 

Since hydrocyanic acid produces asphyxia most rapidly in the 
form of vapor, Preyer concludes that it acts directly on the pul- 
monary ends of the vagi. That it acts directly on the nerve- 



* Arch, fur Pathol. Anat., Bd. x, p. 272. 



308 MATERIA MEDICA AND THERAPEUTICS. 

centres is supported by the experiment of Jones,* in which the 
application of the acid to the medulla of an alligator caused quickly 
collapse of the lung. Circulation : prussic acid in small doses has 
a sedative action on the heart ; large doses arrest it in diastole 
(Lecorche et Meuriotf). When applied directly to the heart it 
suspends the movements. Under prussic acid a temporary increase 
of the arterial pressure, followed by a permanent reduction, has 
been observed. But this is not in accordance with Lecorche and 
Meuriot's (loc. cit.) investigations. It is only in lethal doses that 
opinion is unanimous as to a decided reduction of blood-pressure. 

Respiration: nothing short of 10-15 minims disturbs this 
act, this amount rendering it labored and irregular. * Large 
doses destroy life so quickly that the respirations cannot be 
counted. Prussic acid has no influence on temperature, or 
secretion, save a slight augmentation of the saliva. Elimination 
is rapid, taking place by the saliva, kidneys and lungs. Opinions 
as to the action of prussic acid on the blood are contradictory. 
During life, under hydrocyanic acid, the venous blood is found to 
have an arterial hue ; while in man and mammals, after death this 
fluid is dark colored, probably from deficient abstraction of carbon 
dioxide. Outside of the economy the addition of hydrocyanic acid 
to the blood produces a new body, formed from HCy and hemo- 
globin, called cyanohemoglobin (Hoppe-Seyler J), which has no 
ozonizing power, and it seems probable that the formation of this 
substance, if it take place during life in the blood, may be one of 
the main factors in causing death. 

Toxicology. — In a poisonous dose, hydrocyanic acid arrests 
life with fearful rapidity, and it is one of the most energetic poisons 
known, one or two drops of the pure acid being sufficient to destroy 
a dog in a few seconds, and gr. T \ § of the anhydrous acid killed an 
adult in twenty minutes. When not immediately fatal, it produces 
great and sudden prostration, difficult and spasmodic respiration, 
dilatation and immobility, and sometimes contraction of the pupils, 
feeble pulse, diminution of temperature in the extremities, rise 



* N. Y. Med. Record, II, 1867, 456. 

j" Arch. Gen. de Medecwe, 6 ser., xi, p. 529. fetude Phys. et Therap. sur l'acide cyan- 
hydrique. 

\ Virckow's Archives, XXXVIII, p. 435. " Ueber die Ursache der Giftigkeit der 
Blausaure." 

\ "Taylor's Med. Jurisprudence," 3d Am. ed., 142. 



SPINANTS— DILUTED HYDROCYANIC ACID. 309 

in the trunk at first, but followed by a fall, and involuntary evacua- 
tions. It acts on both the voluntary and involuntary muscles, de- 
creasing or arresting entirely their property of contractility ; both 
the sympathetic and cerebro-spinal nervous systems appear to be 
affected. 

Antidotes. — The best antidotes are inhalations of ammonia or 
its carbonate, and (if the patient can swallow) alcoholic stimuli are 
to be employed, and at the same time cold and hot affusions and 
artificial respiration must also be resorted to. The subcutaneous 
injection of atropine sulphate has been proposed as a physiological 
antidote, but its rate of diffusion is too slow to be of service, while 
Boehm * states that it is not antagonistic at all. 

Medicinal Uses. — Hydrocyanic acid is a valuable agent in 
allaying spasm, pain and nervous irritability, in a variety of disorders, 
and is much used to relieve cough, particularly in phthisis pulmon- 
alis,and for its antispasmodic virtues in asthma and whooping-cough. 
It is, moreover, a most efficacious remedy in gastrodynia and in 
neuralgic affections of the bowels, and also in chronic vomiting. 
Topically, it is employed as an anodyne in netiralgia, and in various 
forms of cutaneous disease (f5j-iij to water Oj-iss), notably urticaria 
and prurigo, as an antipruritic lotion. 

Administration, — The dose of the official acid is gtt. i-ij, to 
be repeated and gradually increased by a drop till some effect is per- 
ceptible. When it is taken for a length of time, care should be ob- 
served to have the medicine, as renewed, of uniform strength ; and 
it is best, in using a fresh sample, to return to the minimum dose, 

Potassii Cyanidum [Potassium Cyanide, KCN), is used as a sub- 
stitute for hydrocyanic acid, and has the advantage of being a more 
uniform chemical product, and less liable to undergo decomposi- 
tion. It is made by heating together potassium ferrocyanide and 
potassium carbonate, and occurs in white, opaque, amorphous pieces, 
having a sharp, somewhat alkaline and bitter-almond taste, and an 
alkaline reaction ; its solution yields the odor of hydrocyanic acid 
when exposed to the air. It is deliquescent, very soluble in water, 
and sparingly so in alcohol. For medicinal use it should be puri- 
fied by solution in, and crystallization from, alcohol. Its medicinal 
and poisonous effects are the same as those of hydrocyanic acid. 

Administration. — Dose, gr. y& in fgss of distilled water, to 

* Practitioner, XIII, p 168. 



310 MATERIA MEDIC A AND THERAPEUTICS. 

be repeated and increased. The addition of a few drops of some 
vegetable acid frees the hydrocyanic acid, and the same effect is 
produced by the acids of the stomach. Lethal effects may be ob- 
tained by prolonged contact with the skin. It is also irritant, and 
will produce an eschar. As much as gr. iij have been taken by an 
adult without fatal results (Taylor *). 

Oleum Amygdalae Amarse (Oil of Bitter Almond} contains hydro- 
cyanic acid, and may be used for the same purposes. It is obtained 
by distillation from the kernel of the fruit of Amygdalus communis, 
variety Amara (Nat. Ord. Rosaceae), and is of a yellowish color, 
with a bitter, acrid, burning taste, and the peculiar odor of the bitter 
almond, which is different from that of hydrocyanic acid. It is 
heavier than water, slightly soluble in it, and soluble in alcohol and 
ether. 

Chemical Constituents. — It contains benzoic aldehyde and 
hydrocyanic acid, which are developed from a principle termed 
amygdalin, and water, under the influence of an albuminous ferment 
termed emulsin: thus, amygdalin (C 2 oH 27 NO n ) + water (2H 2 0) = 
benzoic aldehyde (C 7 H 5 OH) + HCN + glucose (2C 6 H 12 6 ). 

Effects and Uses. — The action of this oil upon the system is 
closely analogous to that of hydrocyanic acid, and its strength is 
about four times that of the diluted official acid. 

Administration. — Dose, for internal use, gtt. %-% in emul- 
sion; as an external application, gtt. j to a f§j of menstruum. Bitter 
Almond Water {aqua amygdala amara) is used as a vehicle for 
narcotic medicines containing one part of the oil dissolved in 999 
parts of distilled water. Dose, fgss. 

Syrupus Amygdalae (Syrup of Almond), made from both the 
sweet and bitter almonds, is slightly impregnated with the virtues 
of hydrocyanic acid, and is a pleasant vehicle for cough-mixtures. 
(For mistura amygdala see index.) 

AMYL NITRIS— AMYL NITRITE. 

Preparation. — Amyl nitrite (C 5 H n N0 2 ) is prepared by heat- 
ing one part of strong nitric acid with two parts of rectified 
fusel oil (amylic alcohol or amyl hydrate — QHnHO) until it ap- 
proaches boiling, when the fire is removed. After the violent 
reaction has subsided, heat is again carefully applied. The distillate 

* Guy's Hospital Reports, XIII, 1868. 



SPINA NTS- A MYL NITRITE. 311 

obtained below 21 2° F. is rectified over potassium carbonate, with 
the precaution to collect only that portion distilling between 202 
and 206 F. It is a clear amber- colored, volatile, inflammable 
liquid, of sp gr. 0.872 to 0.874, boiling at about 205 ° F., giving off 
an orange-colored vapor. It has an odor and taste like that of ripe 
pears. It is insoluble in water, but soluble in all proportions in 
alcohol, ether and chloroform. Amyl nitrite should be kept in 
small glass-stoppered bottles, in a dark and cool place. 

Aids. — The depresso-motors, though on account of its pecu- 
liar nature it should be prescribed alone. 

Physiological Effects. — The following account is based on 
the investigations of H. C. Wood,* Amez-Drozand,f and Lauder 
Brunton.J When amyl nitrite is inhaled, it causes flushing of the 
head and face, a feeling of oppression in the head, with vertigo, ex- 
cited cardiac action, diminished blood-pressure, ma,rked dilatation 
of the arterial system, from paresis of the muscular coat of the ves- 
sels, due to direct action of the drug (Lauder Brunton, loc. cit.), 
lowering of temperature, retarded respiratory movements, which 
tend to become slower as the administration is pushed, and eventu- 
ally are extinguished, from a paralyzing influence on the respiratory 
centre. At the same time there is complete motor-paralysis. Con- 
sciousness is not destroyed, unless a condition approaching death 
is produced. 

The violent action of the heart is due, probably, to depression 
of the cardiac inhibitory nerves. On the reflex function and spinal 
motor centres, amyl nitrite acts as a powerful paralyzer. It also 
lessens the functional activity of the muscles and nerves. Dilata- 
tion of the vessels of the retina has been observed by the ophthal- 
moscope. Amyl nitrite has the property of diminishing the 
oxidizing function of the red blood-corpuscles, uniting with them 
to form a new compound, methemoglobin, which is not as readily 
deoxidized as hemoglobin, but which may be again converted into 
the latter by reducing agents. Whether inhaled or administered 
internally, amyl nitrite increases to a marked degree both the 
quantity of urine passed and the amount of uric acid and urea 
eliminated. Sugar has been found in the urine of rabbits to 



* Am. J. Med. Sci., July, 1871, p. 39. 

f Arch, de Phys. Norm, et Pathol., V, 1863, 467. 

XJourn. of Anat. and Physiol., V. p. 92, 



312 MATERIA MEDICA AND THERAPEUTICS. 

which the drug had been administered by hypodermic injection. 
Its lethal effects are antagonized by those agents which excite the 
functional activity of its spinal cord, as strychnia, picrotoxin, etc. 

Medicinal Uses. — It has been employed to rouse the system 
in cases of syncope and prostration, as an antidote to chloroform 
poisoning, and it has been found efficacious in relieving the pain of 
angina pectoris, puerperal eclampsia, and other convulsive diseases, 
and Frazer* has recently called attention to the value of the inhala- 
tion of amyl nitrite to relieve the dyspnoea of asthma. In uremic 
asthma especially are the good effects of an inhalation of the drug 
seen, the relief being very speedy, the quantity of urine much 
augmented, and the amount of albumen lessened, at the same time 
the oedema decidedly subsides (Ringwood ; Rossbach ; Mya). In 
dyspnoea due to cardiac failure, it is also beneficial. In dysmenor- 
rhea of the so-called congestive form, it often proves serviceable. 
The inhalation of the vapor of the nitrite has also been found 
efficacious in arresting epileptic seizures, when their approach is 
indicated by the aura epileptica ; and also in tetanus, nausea marina, 
and strychnine poisoning. Dr. Macdonald f recommends its use in 
gout, on account of the rapid elimination of uric acid which it causes. 

It is indicated in all conditions where there is a high degree of 
tension of the arterioles. 

Administration. — It may be conveniently carried in glass- 
pearls by patients requiring jts prompt action, or Tflj-v can be in- 
haled from a crushed capsule. 

The following drugs, although not official, are deserving of 
notice in connection with amyl nitrite. 

Nitroglycerinum {Nitroglycerin — Trinitroglycerin — Glonoin (C 3 
H 5 (N0 3 ) 3 ) is made by the action of sulphuric and nitric acids on 
glycerin, and occurs as a colorless or pale yellowish, oily liquid, 
with a sp. gr. i\6oo ; it crystallizes in long needles if kept for some 
time at the temperature of 32 F. ; is nearly insoluble in water, but 
readily soluble in alcohol and ether, It is without odor. Nitro- 
glycerin forms the basis of various explosives, as dynamite , giant 
powder, etc., and will itself explode with great violence if heated in 
a closed vessel or if forcibly percussed. Hay J has made some 
experiments which seem to show that nitroglycerin is a nitrate of 
glyceryl. 

* Am. J. M. Sci., Oct., 1887, p. 393. f Brit. Med. Jonrn., 1885, p, 1039. 

X The Practitioner, ocxx, p. 422. 



SPINA NTS— AM YL NITRITE. 313 

Physiological Effects. — The effects of nitroglycerin resemble 
those of amy 1 nitrite and the other nitrites, but are more persistent. 
Hay [loc. bit.) considers their similarity of action to be due to the 
nitrous -radical contained in each, which coincides with the view 
expressed by a recent experimenter (Armstrong*) and it appears to 
be substantially correct. When inhaled it causes flushing of the 
face and headache. Given internally, in small dosesf (gr. jh), 
its taste being sweetish and pungent, it causes very great accelera- 
tion of the pulse and respiration, diminished blood-pressure, flushed 
face, a feeling of tension and throbbing, and severe headache, 
pharyngeal constriction, diaphoresis, all lasting some hours. After 
larger doses all of these symtoms are intensified ; there is gradual 
paralysis of reflex and voluntary motions, loss of sensation, and 
finally death from paralysis of respiration. Injected into cats 
Bruntont found that it produced paralysis without tetanus, and in 
addition it poisoned the muscles. On the motor-nerves its action is 
uncertain. It paralyzed the cord before the ganglia at the base of 
the brain; slowed the action of the heart directly, and reduced the 
blood-pressure. It is decomposed by the alkalies in the blood, the 
greater portion of the nitric acid of the compound being converted 
into nitrous acid and combining with alkaline bases, forming nitrites 
which lessen the oxidizing power of the red corpuscles and cause 
both arterial and venous blood to assume a dark chocolate hue. 
Nitroglycerin is a muscle-poison, and when applied directly to the 
heart of the frog causes paralysis of that organ. Prof. Rossbach, 
of Jena, finds it greatly increases both the quantity of the urine 
and the amount of uric acid and urea present. 

Toxicology. — Three fatal cases§ are recorded, but the amount 
is not given. Its poisonous effects are antagonized by the same 
agents as for amyl nitrite. 

Medicinal Uses. — Nitroglycerin is used to relieve the tension 
of the vessels, as in angina pectoris, in which disease there is pre- 
eminently a high arterial tension. If taken at the beginning of the 
attack of asthma (especially if due to emphysema), it will frequently 
give good results (Korczynski). In uremic asthma it is often use- 
ful, but if the symptoms are urgent, it is best to let the patient in- 

* Med. Times, Feb., 1888, p. 260. 

f British Med. Journal, March, 1880, vol. 1, p. 406, article on nitro-glycerine. 

% St. Bartholomew's Hospital Reports, xii, 1876, p. 140. 

§ Woodman and Tidy, 1882, p. 464. 



314 MATERIA MEDIC A AND THERAPEUTICS. 

hale amyl nitrite until the danger is abated, after which nitroglycer- 
in should be administered. 

In purperal eclampsia it has been of great service, and has 
also been recommended in dyspnoea, due to cardiac failure, and in 
weak-heart, or where fatty degeneration of the cardiac muscle is 
taking place ; although many prefer the use of amyl or other 
nitrite in these cases. It is also useful in Bright s disease, both in 
the acute and chronic forms. It sometimes affords relief in neu- 
ralgias, in gastrodynia, and in hepatic colic, and has been found useful 
to arrest the vomiting of sea-sickness. It has also been prescribed 
with success in the cold stage of intermittent fever, as by dilating 
the vessels it will frequently abort or cut short the attack: 

Administration. — It is best given in one per cent, solution 
in alcohol, of which the dose is Tttss-x. It is best to begin with 
a small dose and gradually increase it. 

Potassium Nitrite and Sodium Nitrite have been introduced 
into practice as being similar in effects and uses to those of amyl 
nitrite and nitroglycerin, and this similarity has recently been cor- 
roborated by Armstrong (loc. cit.) and Reichert* in some experi- 
ments on the pharmacology of the nitrites. Dr. Matthew Hayf 
believes the sodium salt to be as active and reliable in angina pec- 
toris as either of the above drugs, and prefers it, because when 
used in medicinal doses, it does not cause the headache, giddiness, 
or even partial collapse, which are sometimes seen after their use. 
The nitrites have recently been recommended in asthma by Fraser. 
Dose, gr. iij-v or more, in aqueous solution. 

GELSEMIUM. 

Gelsemium sempervirens, Yellow or Carolina Jasmine (Nat. Ord. 
Loganiaceae), is a beautiful climbing plant of our Southern States, 
with a twining, smooth, and shining stem, perennial, dark-green 
leaves, and beautiful, very fragrant flowers, of a deep-yellow color. 
The rhizome and rootlets are official. The true root is hard and 
woody, slightly undulated in outline, sparingly branched, extern- 
ally of a pale-brown color, smooth, and furnished with a thin 
scurfy cuticle, slightly cracked longitudinally. The stem is rougher 
externally, and is distinguished from the root by a small central 
cavity, representing the pith. The stem should be rejected. The 

* Am. Jour. Med. Sci., Vol. 80, p. 158. f Practitioner, March, 1883. 



SPINANTS—GELSEMIUM. 315 

root has a bitter and pleasant flavor, and an odor somewhat be- 
tween that of senega and green tea. 

Chemical Constituents. — It contains an alkaloid termed gcl- 
semine, combined with an acid called gelseminic, both discovered by 
Wormley * (not identical with aesculin), a volatile oil, an acrid resin, 
etc. The alkaloid, which represents chiefly the physiological action 
of the drug, though Ott| has shown gelseminic acid, gr. j-^ in- 
jected into cats to be a fatal tetanizer, is a powerful poison. 

Imcompatibles. — The caustic alkalies and tannic acid precipi- 
tate the alkaloid. 

Aids. — The depresso-motors as, tobacco, physostigma, conium, 

etc. 

Fig. 29. 




GELSEMIUM SEMPERVIRENS. 



Physiological Effects. — The action of gelsemium has been 
investigated and described by the following observers, viz., Bar- 
tholowj Ott (loc. cit), Ringer and Murrell§ and Holmes,|| as fol- 
lows: Gelsemium in moderate doses, causes languor, dizziness, dis- 
ordered vision and frontal pain, but hardly affects the circulation. 
Large doses diminish the pulse and blood-pressure by direct action 
on the heart, lower the temperature of the body, lessen respiration, 
and dilate the pupils, with little or no nauseating or purgative effect, 
nor does it exhibit any characteristic influence upon the brain. Ott's 
(loc. cit.) conclusions are these, viz., that gelsemine has no action on 



* Am. Journ. of Pharm., Jan., 1870, and July, 1882. 

f Phil. Med. Times, V, July, 1875, and March 31, 1887. 

X The Practitioner, V, p. 200. 

\ The Lancet, Jan. 15th, 1876. 

|| Annuaire de Therap., 1877, p. 41. 



316 MATERIA MEDIC A AND THERAPEUTICS. 

the motor or sensory nerves, nor on muscular contractility, which 
are in accord with those of Bartholow (loc. at.); the last observer 
concludes that its paralyzing influence is due to a direct action on 
the motor and sensory centres of the cord. It appears to slow the 
heart by direct action, and it destroys life by paralysis of respira- 
tion. By summing up its action, after examining the effects of 
lethal doses, and the results of experiments, we can deduce the fact 
that gelsemium is a powerful depressant, not only of the motor, but 
also of the sensory centres, in the spinal cord. 

Toxicology and Antidotes. — In overdoses, it has rapidly 
produced death, with great muscular relaxation, want of coordina- 
tion in the movements, difficulty of speech, double vision, dilatation 
of the pupils, failure of the pulse and respiration, coldness of the 
surface, and finally unconsciousness preceding death. Ott* has 
collected six cases of fatal poisoning by Gelsemium, the minimum 
dose being f5j of the fluid extract. An amount of gelsemium esti- 
mated to contain gr. J of gelsemine has proved fatal to an adult 
woman. Its lethal effects are counteracted by the cardiac and 
motor-excitants, as strychnia, ammonia, alcohol, etc. 

Medicinal Uses. — It has been used in fevers, inflammations, 
essential spasmodic affections, as tetanus, paralysis agitans, and as 
an hypnotic in delirium tremens and other forms of morbid wakeful- 
ness, and as an anodyne in trifacial neuralgia. As a calmative in 
acute mania it has been given in full doses, and as a depresso-motor 
against erotic desires leading to masturbation. Bartholow recom- 
mends gelsemium in acute inflammations of the lungs and pleura, 
especially in pneumo7iia and pleurisy. He gives the fluid extract 
TVLv-x every two hours "to maintain a constant effect within the 
limits of safety." Bulkley f advises the internal use of tincture of 
gelsemium gtt. x, repeated, to relieve the itching of acute eczema 
and prurigo. 

Administration. — The tincture of gelsemium is the form which 
has been heretofore employed, in the dose of Tltv-xx; but the fluid 
extract should be preferred, dose, Tftv-x; f5j of this has proved fatal. 

woorara. 
This substance, termed also woorari, woorali, and curare, has 
long been known as a powerful poison prepared by the Indians, in 



* Phila. Med. Times, Vol. v, p. 689. f N. Y. Med. Journ., Jan., 1881. 



SPINANTS—WOORARA. 317 

South America, and of late years has been employed as a medicine. 
its source is unsettled, but it is generally considered to be an ex- 
tract from the bark of Strychnos toxifera and other species of Strych- 
nos. It is brought from the banks of the Orinoco, and occurs in 
the form of dark-brown or grayish lumps or powder, soluble in 
water, of an intensely bitter taste, and, when triturated, of a powerful 
odor. An alkaloid termed curarine (C 18 H 35 N) has been extracted 
from woorara, which is said to exist as a sulphate (Sachs). Re- 
cently (1886) another alkaloid termed curine has been discovered 
by Bohm. k 

Incompatibles. — The caustic alkalies and tannin decompose 
the alkaloids. 

Aids. — The depresso-motors, as physostigma and conium. 

Physiological Effects. — Woorara, topically applied, is an ir- 
ritant. It is ranked with the motor-depressants, and is considered 
to destroy life by paralysis, more or less rapid, of the respiratory 
muscles. A peculiarity of its action is that it is comparatively in- 
nocuous when taken by the stomach, being either not absorbed at 
all in this viscus, or so slowly as to allow of its elimination by the 
kidneys before dangerous accumulation in the blood. According 
to Lauder Brunton, on introduction into the stomach the absence 
of poisonous effects of curare is due, probably, to its being passed 
round the entero-hepatic circulation. Hence, for therapeutic pur- 
poses, it must be employed either endermically to a blistered surface 
or by hypodermic injection. Woorara paralyzes the intra-muscular 
motor-nerve endings without affecting the muscular irritability, and 
destroys the reflex function of the spinal cord : in other words, the 
paralysis induced by it is peripheral and not centric; eventually, 
however, the paralyzing action of woorara extends to the nerve- 
trunks and centres. The cerebrum is only secondarily involved. 
Woorara stimulates and then paralyzes the accelerator cardiac 
nerves. Other effects of woorara are elevation of temperature, in- 
creased nasal, salivary and intestinal secretions, and diabetic urine 
(in animals). The elimination of curarine has been distinctly shown 
to take place, in part, by the kidneys. Artificial respiration retards 
the poisonous effects of the drug; also the tetanizers, and chloral 
to a certain extent. 

Medicinal Uses. — Woorara, or curarine, is only applicable to 
the treatment of those affections which therapeutically require motor- 
depressants to antagonize the disease process. Among the most 



318 MATERIA MEDIC A AND THERAPEUTICS. 

prominent of these are tetanus and hydrophobia. In tetanus good 
results have been obtained from its use in large doses, while from 
hydrophobia there are two reported cases of recovery. It has also 
been employed in chorea, epilepsy \ and paralysis agitans. The dose 
of woorara is from T V to \ of a grain. Of curarine, from gr. jfo to 
Tib, hypodermically. Caution must be enjoined, as the samples 
vary. 

VIBURNUM. 

Viburnum is the bark of Viburnum prunifolium, commonly 
known as the Sloe or Black Haw (Nat. Ord. Caprifoliaceae), a small 
tree growing in thickets in the Southern and Western States, with 
opposite, oval, obovate, sharply serrulate leaves about two inches 
long, and short, slightly marginal petioles. It has small white flowers 
in terminal cymes, appearing in May ; and small blue-black edible 
drupes containing a flattish, smooth putamen. The bark is in thin 
pieces or quills of a purplish-brown color, with scattered warts and 
minute black dots ; collected from the old wood it is a grayish- 
brown, the thin corky layer easily removed from the green layer ; 
the inner surface is whitish and smooth ; it breaks with a short 
fracture ; is without smell, and of a bitter, astringent taste (Stille and 
Maisch ; Maisch). It contains valerianic acid, a brown bitter resin, 
a greenish-yellow bitter-principle (viburnin), tannin, etc. 

Incompatibles. — As it contains tannin it is incompatible with 
the substances precipitated by this agent. 

Effects and Uses. — The physiological effects of viburnum are 
not understood. It probably acts as a sedative to the spinal centres, 
especially those governing the uterine functions ; but whether it 
influences the circulation or the blood-supply to the uterus, or what 
action, if any, it has on the sympathetic ganglionic system are 
questions for the future to determine. It is said that no disagreeable 
after-effects attend its use. 

Viburnum has been administered as a sedative in cases of 
threatened abortion* whether accidental or due to the action of 
drugs, and it is said to be especially serviceable where a tendency to 
abortion exists from habit. In these cases 5j may be given every 
two or three hours as long as the abortion is threatening. It is also 
recommended to allay the severity of after-pains, and is one of the 
numerous remedies which have been used for the relief of the vom- 

* Liverpool Med. and Surg. Journal, 1875, P« 4 1 - J- H. Wilson, 



SPINA NTS— GRIN DELI A . 319 

Uing of pregnancy. It has also been employed with success in 
Menorrhagia and metrorrhagia, depending on anemia, debility or 
other systemic cause, and in menorrhagia accompanied with nervous 
symptoms appearing at the climacteric period. It has been given, 
too, in dysmenorrhcea* with profuse discharge, accompanied by a 
feeling of weight in the pelvis, and may be combined with other 
remedies in the treatment of neuralgic dysmenorrhcea, The fluid 
extract is official, the dose of which is f5ss-j. 

GRINDELIA. 

Grindelia is the leaves and flowering tops of the Grindelia 
robusta {Nat. Ord. Composite), an herbaceous perennial plant grow- 
ing to the height of one or two feet, indigenous to the Pacific coast. 
It resembles the common sunflower in its general appearance, and 
contains vegetable wax, fixed and volatile oils, a greenish, soft, acid 
resin having the odor of the drug, an acid saponin-like body (grinde- 
lin), a trace of tannin, but no alkaloid (W. H. Clarkf). 

Incompatible. — The volatile oils and resin of grindelia are 
not miscible with preparations containing water. 

Aids. — The depresso- motors. 

Physiological Effects. — In large doses, grindelia exerts a 
decided hypnotic effect, during which the pupils are dilated and reflex 
action, motion, and sensation are depressed. Buffington'sJ investi- 
gations give the following results: the cardiac action is slowed by 
grindelia, through stimulation of its inhibitory centre, while the local 
blood-pressure is raised. The statement as to the slowing of the 
heart and reduction of blood-pressure are confirmed by Dobrok- 
lonsky.§ The respiratory movements are increased in frequency by 
an action of the drug on that centre. It is eliminated by the kid- 
neys, inducing a marked increase in the urinary flow and to a certain 
extent by the lungs. The statement in regard to its diuretic action 
is not confirmed by Dobroklonsky (loc. cit.), who affirms that it is 
feebler in this respect than digitalis. Grindelia is not actively toxic, 
though a lethal dose will destroy life by arrest of respiration. Its 
poisonous effects are counteracted by the spinal excitants, strychnia 
for example. 

*" New Preparations," 1879, P> I 37- 

f American Jour, of Pharmacy, Sept., 1888. 

% Am. Journ. Med. Sci., Jan., 1886. 

\ These de St. Petersburg. Quoted by Bull. Gen. de Tkerap., CXI, 277. 



320 MATERIA MEDIC A AND THERAPEUTICS. 

Medicinal Uses. — Grindelia is very serviceable in the treat- 
ment of asthma, especially in the uncomplicated spasmodic form, 
but it has also proved useful when this disease is compli cated with 
bronchitis. In many cases of hay-asthma and hay-fever it has 
proved of much benefit. It is useful in whooping-cough, and is also 
recommended in acute and chronic bronchitis and pneumonia. Dr. 
H. M. Fiske recommends its internal and local use in iritis. It has 
been used as an injection in vaginitis and as a local application in 
poisoning by rhus toxicodendron, the latter with varying results. 
The fluid extract is official, the dose of which is 1flfLx-f5j. 

SUMBUL. 

Sumbul is the root of the Ferula Sumbul (Nat. Ord. Umbelli- 
ferae), a perennial plant, growing to the height of eight feet, with 
large triangular, tripinnate radical leaves and a few small cauline 
leaves. It is a native of Turkestan and eastern Siberia. The root 
reaches us through Russia, and is met with in transverse slices from 
one to five inches in diameter and three-quarters to two inches thick. 
It is light, spongy, annulated, with a' thin brownish bark and a 
whitish interior, with numerous dots of brown-yellow resin and 
irregular, easily separated fibres; of a strong musk-like odor and a 
bitter balsamic taste. The root of the Dorema ammoniacum is 
sometimes flavored with sumbul, but may be distinguished from it 
by being firmer, denser, and of a yellow or reddish tint (Stille and 
Maisch). 

Chemical Constituents. — Sumbul root contains a volatile oil, 
a soft resin , angelic and valerianic acids (Maisch). The soft oleo- 
resin is soluble in ether, exists in the proportion of 9 to 1 00, and 
imparts to water the odor of musk (Remsch). * 

Effects and Uses. — The physiological effects of sumbul are 
not accurately known. It probably acts as a sedative to the brain 
and spinal cord. It was originally introduced into Russia as a 
remedy for cholera, and is still used there in asthenic dysentery and 
diarrhoea. In England it has been used in dysmenorrhoea, hysteria, 
epilepsy, and various allied nervous disorders. Mr. Murawieff recom- 
mends it in chronic bronchitis in old and debilitated patients, in 
humid asthma and hysteria, and Phillips has seen it prove useful in 
chronic bronchitis. He also recommends it in severe cases of facial, 
sciatic, or ovarian neuralgia. Boehm (Ziemssen's Cyclopcedid) 

* Jo urn. de Pharm. et de Chimie, 4ieme ser., 1871, p. 320. 



EMETICS. 321 

speaks favorably of it in delirium tremens. It is not much used in 
this country. The tincture may be given in doses of TTl x— f 5j . 



CLASS II.— ECCRITICS. 

ORDER I.— EMETICS. 

Emetics (from 'e/ieco, I vomit) are medicines which are em- 
ployed to promote vomiting ; when they are used merely to excite 
nausea, they are termed nauscants. When an emetic is adminis- 
tered, usually within fifteen or twenty minutes afterward a feeling of 
distress, relaxation and faintness is experienced, with coolness and 
moisture of the skin and a small, feeble, irregular pulse. These 
symptoms increase till the contents of the stomach are ejected. 
During the act of vomiting, the face becomes flushed, the pulse is 
full and frequent, and the temperature of the body is increased. 
After vomiting is over, the skin is moist, the pulse soft and feeble, 
the patient becomes languid and drowsy, and, under peculiar cir- 
cumstances, alarming and even fatal syncope has been induced. 
Emetics act either directly on the centres of the medulla which 
govern the act of vomiting, or by the local irritation they produce, 
which, being conveyed to the centre by filaments of the pneumo- 
gastric nerve, produces vomiting in a reflex manner. In the former 
case, vomiting is produced by the drug, no matter in what manner 
it enters the system, and it is therefore called a systemetic emetic ; 
in the latter, vomiting is only produced by the introduction of the 
substance into the stomach, and it is hence called a local emetic. 
Some agents, however, act in both ways, as copper sulphate. Re- 
flex vomiting may be excited by irritating the fauces, as with a 
finger or feather. Dr. Marshall Hall gives the following summary 
of the mechanism of vomiting: " During the act of vomiting, I, 
the larynx is closed; 2, the cardia is opened; and 3, all the muscles 
of expiration are called into action ; but, 4, actual expiration being 
prevented by the closure of the larynx, the force of the effort is 
expended upon the stomach, the cardia being open, and vomiting is 
effected." 

Susceptibility to the action of emetics differs in different indi- 
viduals and in different diseases. In fevers, and where gastric irri- 
tation is present, their influence is increased ; and, on the other 
hand, when the brain is oppressed by disease or by narcotic medicines, 



322 MATERIA MEDICA AND THERAPELT1CS. 

the stomach is exceedingly insensible to their action. Children 
vomit more readily than adults, because the stomach of a child has 
no fundus. 

Medicinal Uses. — Emetics are employed therapeutically — I, 
to evacuate the stomach, for the purpose of removing poisons, 
undigested food, etc. ; and, with this view, the emetics should be 
selected which occasion least nausea and distress; 2, to expel for- 
eign bodies lodged in the throat or oesophagus; 3, to excite nau- 
sea, and thereby depress the vascular and muscular systems, thus 
acting as anaphrcdisiacs ; 4, to relieve spasm, as in spasmodic croup, 
hiccough, laryngy sinus stridulus \ and convulsions; 5, to promote se- 
cretion and excretion, etc. ; and 6, sometimes to break up a train 
of morbid associations, by giving a shock to the system, as in the 
forming stages of certain fevers, as typhus and scarlatina, and of 
delirium tremens. 

Contraindications. — They are improper where the effort of 
vomiting is liable to increase any existing pathological conditions, 
as in congestion of the brain, pregnancy, hernia, etc., or where 
such debility is present that the depressing effects might prove 
fatal, as in the last stages of membranous croup. 

The act of emesis is promoted by the free use of tepid drinks ; 
excessive vomiting may be checked by demulcents, opiates, coun- 
ter-irritation to the stomach, etc. 

VEGETABLE EMETICS. 
IPECACUANHA-IPECAC. 

Ipecacuanaha is the root of Cephaelis Ipecacuanha (.Nat. Ord. 
Rubiaceae), a small shrubby perennial plant of Brazil, where it 
grows to the height of about five or six inches. 

Description. — The roots, as met with in the shops, are in 
pieces about the size of a quill several inches long of an irregu- 
lar, twisted, contorted shape, with numerous circular rings or rugae, 
from which they have been termed annulated. When broken, 
they are seen to consist of two distinct parts — a thin ligneous axis 
or centre, which is nearly inert, and a thick, cortical layer, which 
has an herbaceous, acrid, rather bitter taste and a slightly nauseous 
odor. A distinction is made of black, red and gray ipecacuanha, 
from differences in the color of the epidermis; but they are all 
derived from the same plant, and are the same in properties and 
composition. The black is the most common variety in our mar- 
ket. The powder is of a light grayish-fawn color, and has a pecu- 



EME riCS—IPECA C. 



323 



liar nauseous odor, which in some persons excites violent sneezing - , 
in others, dyspnoea. Ipecacuanha imparts its virtues to both water 
and alcohol, but they are injured by decoction. 

Chemical Constituents. — Its emetic property depends on the 
presence of an alkaloid, termed emetine (C 30 H 40 N 2 O 5 ) (Kunz *), which 
exists in connection with ipecacnauJiic acid. Emetine is a whitish, 
inodorous, slightly bitter substance, sparingly soluble in water and 
ether, and very soluble in concentrated alcohol and chloroform. 
It produces vomiting in the dose of gr. J^, and in overdoses may 

Fig. 30. 




CEPHAELIS IPECACUANHA; a, b, ROOT; a, ANNULATED PORTION. 

occasion dangerous and even fatal symptoms. Occasionally a sophis- 
ticated root, that of Psychotria emetica, derived from New Granada, 
is found in the markets ; this is not annidated, but longitudinally 
striated, and contains less than half the quantity of the emetine 
found in the genuine root (ij4 per cent). 

Incompatibles. — Tannic acid, the astringent infusions, caustic 
alkalies, and metallic salts. 



* Arch, der Fhar?nacie, 1887, p. 461. 



324 MATERIA MEDIC A AND THERAPEUTICS. 

Aids. — The emetics, as apomorphia, also warm diluents. 

Physiological Effects. — Locally, powdered ipecac is an irri- 
tant to raw surfaces and to the mucous membranes, causing violent 
sneezing, etc. When rubbed into the sound skin it causes pustula- 
tion and even ulceration. Nervous system : it stimulates the centre 
of the medulla oblongata which presides over the act of vomiting, 
and somewhat diminishes the reflex activity of the cord. The fol- 
lowing observers, viz. : D'Ornellas,* Phillips, f and Duckworth, % 
ascertained that emetine, in animals, always caused vomiting, given 
either by the stomach or subcutaneously. D'Ornellas (Joe. eit) and 
Duckworth (Joe. eit) found, too, that when the vagi were divided in 
the neck the alkaloid was powerless as an emetic. Toxic doses (in 
animals) generally destroy life by paralyzing the respiratory centres, 
the nerves probably remaining unaffected. Circulation : moderate 
doses probably do not affect the circulation ; very large doses in- 
jected into the jugular vein of dogs have killed by cardiac paralysis. 
Temperature : in the mouth and on the surface the temperature falls 
in cases of emetine poisoning, but in the intestines it rises (from the 
irritant action of the poison). Secretion : repeated small doses re- 
lax the skin and increase the perspiration, saliva and the bronchial 
and gastric mucus. Rutherford states that it has the power of 
stimulating the secreting apparatus of the liver (in dogs), and that 
the consequent augmented secretion of bile is normal in composi- 
tion as regards the biliary matters proper. It also increases the 
secretion of intestinal mucus. Gastro-intestinal tract: it is an irri- 
tant to the stomach, producing vomiting by local irritation as well 
as by direct action on the medulla. Elimination takes place by the 
gastro-intestinal mucous membrane, and also by other secretions. 

Medicinal Uses. — In full doses, ipecacuanha is a mild and 
certain emetic, well adapted to the treatment of spasmodic croup 
and acute bronchitis in children, and to all cases where a. simple 
evacuation of the stomach is desired. In smaller doses it produces 
nausea, depression of the pulse, expectoration and diaphoresis, and 
with these views it is employed in the treatment of pulmonary affec- 
tions, as acute bronchitis ; also in acute dysentery, and inflammatory 
disorder generally. In still smaller doses it is useful as a tonic 

* Bull. Gen. de Therap., LXXXIV, pp. 193, 244, 348 : Du Vomissement, etc. 
^Practitioner, London, III, p. 276. " On the action and uses of ipecacuanha. ' 
\ Ibid., Vol. v. p. 218, and Vol. VII, p. 91. '' Observations upon the action of ipecacu- 
anha," etc. 



/•'. l /A" / 7 t : v - TPE CA C. 325 

and stomachic. At the onset of yellow fever an ipecacuanha emetic 
followed by a full dose of quinine may be given. 

Ipecacuanha was first introduced as a remedy in dysentery, and, 
after being for a time laid aside, has been again taken up with marked 
success. It is particularly of value in epidemic dysentery, and in 
India is used in very large doses in this affection, as much as 5ij 
being sometimes given every few hours. Good effects often 
follow its use in acute dysentery of sporadic kind, especially 
when occurring in puerperal women, given in doses of gr. 
xv-xx combined with opium every three or four hours. If no 
effect is produced by the ipecac-treatment of dysentery in two 
days, it is best to abandon it. It is also used with advantage in 
the vomiting of sick headache, and will sometimes, when given in 
small doses, frequently repeated, arrest the nausea and even the 
vomiting of pregnancy (Fuller *). The wine or fluid extract (in 
drop doses) is best for this purpose. Given ia pills containing gr. 
%-^i before meals, it is of service in dyspepsia accompanied by 
deficiency of gastric and biliary secretions. As it stimulates the 
secretory apparatus of the stomach and liver, the rationale is ob- 
vious. 

Administration. — Dose, as an emetic, gr. xv-xx ; as a nause- 
ant, gr. ss-ij, three or four times a day; as an expectorant or dia- 
phoretic , gr. %-y 2 , repeated; as a tonic, gr. T V, repeated. The fluid 
extract is used as an addendum to expectorant and diaphoretic mix- 
tures, and in bronchitis is advantageously combined with the syrup 
of wild cherry and morphine. As an emetic, the dose is fSss-j ; 
the wine [vinum ipecacuanhce) contains fluid extract 7 parts in 
stronger white wine 93 parts ; dose, as an emetic, f§ss-j ; fluid ex- 
tract, 5 parts, mixed with simple syrup, 95 parts, makes syrupus 
ipecacuanhce, an excellent preparation for children — f§j containing 
gr. xxx of ipecacuanha ; for a child a year or two old, f 5ss-j may 
be given as an emetic, and gtt. x-xx as an expectorant. Pidvis ipe- 
cacuanlice et opii (formerly called pidvis ipecacuanlice compositus, or 
Dover 's powder) contains powdered ipecac and opium each gr. j, 
sugar of milk gr. viij (see p. 89) ; a tincture of ipecac and 
opium is also official (see p. 89). Troches of ipecacuanha (contain 
also sugar, fragacanth, and syrup of orange-peel), each troche con- 
tains ipecac gr. V^. Troches of morphine and ipecac each contain 

* Lancet, London, Dec. 4th, 1869, p. 268. 



326 MATERIA MEDICA AND THERAPEUTICS. 

morphine sulphate gr. &, ipecac gr. T V, with sugar, oil of gaultheria 
and mucilage of tragacanth. 

SANGU1NARIA. 

The rhizome of Sanguinaria canadensis, or Bloodroot (Nat. 
Ord. Papaveraceae), a small indigenous plant, with radical, lobate 

Fig. 31. 




SANGUINARIA CANADENSIS. 



reniform leaves and a handsome white eight-petaled flower, which 
appears in early spring, is usually classed with emetics. When dried 
it comes in flattened pieces, much wrinkled and contorted, of a 
reddish-brown color, with a faint narcotic odor and a bitterish very 



EMETICS— SANGl JNARL I. 327 

acrid taste. It yields its virtues to water and alcohol, and loses 
them very rapidly by keeping. An alkaloid, sanguinarine (C 19 H 17 - 
N0 4 ), has been obtained from it which possesses the properties of 
the root. 

Ixcompatibles. — The alkalies, tannic acid and metallic salts. 

Aids. — The vegetable and mineral emetics. 

Physiological Effects. — Locally, it acts as an irritant, and 
upon fungous surfaces, as an escharotic. Bloodroot is an acrid 
emetic, and, in large doses, an acro-narcotic poison. When inhaled, 
the powder causes violent sneezing. Bloodroot has a persistent, 
bitter taste, and in passing to the stomach leaves a feeling of con- 
striction about the throat. In large doses it causes collapse, dilated 
pupil, and sometimes convulsions of spinal origin, and it diminishes 
reflex activity. After nauseating doses the pulse and arterial pres- 
sure are increased, but when enough is taken to produce vomiting 
the pulse is slow and irregular and the arterial tension is lowered. 
After poisonous doses the respiration becomes shallow and slower, 
and death takes place from asphyxia, due to paralysis of the respi- 
ratory centre. 

Sanguinaria* produces salivation and increases the secretion of 
the gastric mucous membrane. It stimulates the liver and intes- 
tinal glands, increasing the secretion of bile, but at the same time 
rendering it more watery (Rutherford). It is an active systemic 
emetic, causing much depression and irritation of the mucous 
membrane. 

Medicinal Uses. — It is not much employed as an emetic, but 
is occasionally exhibited with this view in croup and diphtheria, or as 
an expectorant in pulmonary affections. ' In duodenal catarrh and 
catarrhal jaundice it has been used with advantage. It has also been 
prescribed as an emmenagogue in amenorrhea. Dose, as an emetic, 
gr. x-xx, in pill. Tincture — dose as an emetic, f5»j or iv ; as an ex- 
pectorant, Tftv-xxx. The vinegar (acetuni) contains ten per cent. 
by weight of the powdered drug. The fluid extract should be 
used with care, as it is a powerful preparation ; dose, as a nauseant, 
TTUj-v ; as an emetic, TTLxv-f5. 



::: For the details of a complete investigation of the action of Sanguinaria consult Am. 
J. M. Sci., Oct., 1876, p. 346, by R. M. Smith, M. D. 



328 MATERIA MEDICA AND THERAPEUTICS. 



APOMORPHINE HYDROCHLORAS — APOMORPHINE HYDROCHLORATE. 

Apomorphine (C 17 H 17 N0 2 ) is an artificial alkaloidal substance ob- 
tained by heating morphine or codeine with hydrochloric acid under 
pressure, the acid subtracting one molecule of water from a mole- 
cule of morphine, and leaving apomorphine (C 17 H 19 N0 3 =H 2 + 
C 17 H 17 N0 2 ). When apomorphine is treated with hydrochloric acid 
it combines to form the official salt. When pure it is a white 
powder, but it absorbs moisture readily, becoming green, which 
change, however, is said not to impair its therapeutic properties. 

Physiological Effects. — Given to animals in large doses, it at 
first stimulates the nerve-centres and afterward paralyzes them. Con- 
vulsions are produced, but their origin is not precisely determined, 
and it is a poison to the muscular system.* Small doses increase 
the cardiac action and elevate the blood-pressure, but when large 
doses are taken, the cardiac movements are probably slowed and the 
pressure diminished. According to Reichart (loc. cit.), it quickens 
the heart's beats by stimulation of its- accelerator fibres, and slows 
it by a direct repressing influence on its muscular substance. Very 
large doses may have a decided sedative action on the circulation 
(in man), and even induce syncope. Large doses at first increase 
the number of the respiratory movements, but afterward diminish 
them. A poisonous dose destroys life by asphyxia, death being due 
to the action of the drug on the respiratory centre. Apomorphine 
is chiefly of interest therapeutically on account of the emesis which 
follows its administration, to which attention was first called, we 
believe, by Dr. S. J. Gee.f It is a prompt and efficient systemic 
emetic, causing vomiting within a half hour after it is taken, which 
is repeated two or three times at intervals of about fifteen minutes, 
and is attended by slight nausea and usually little or no depression. 

Medicinal Uses. — Apomorphine may be used as an emetic 
hypodermically or by the stomach, in cases of narcotic poisoning 
or where it is desirable to evacuate the contents of the stomach 
promptly. It has also been used as an expectorant in both acute and 
chronic bronchitis, and in the capillary bronchitis of infants. Trous- 
seau recommends it in hemoptysis. Dose of the hydrochlorate, (the 



* Phila. Med. Times, Dec, 1879, E. T. Reichert. " Physiolog. Action of Apomorphine 
hydrochlorate." 

| St. Barthol. Hosp. Reports, v, 215. 



CATHARTICS. 329 

same as that of the pure drug), gr. T \ hypodermically, or y& or per- 
haps ]/± by the stomach. It should be given cautiously, on account 
of the depression which occasionally accompanies its action. 

Sinapis {Mustard). The powdered seed of Sinapis nigra and 
Sinapis alba {Nat Ord. Cruciferae), in doses of from a teaspoonful 
to a tablespoonful, are very useful emetics, particularly in atonic 
conditions ,of the stomach. 

Tobacco and Lobelia act as emetics in large doses, but their 
employment is attended with danger, owing to the great prostration 
which they produce (see pp. 301 ; 304). Squill also possesses 
emetic powers, but it is too irritating for use in this respect. 

MINERAL EMETICS. 

Tartar Emetic. Dose, gr.j-ij (see p. 251). 
Zinc Sulphate. Dose, gr. x-xx (see p. 204). 
Copper Sulphate. Dose, gr. iij-v (see p. 203). 
Alum. Dose, a teaspoonful (see p. 21 1). 

Yellow Mercurial Subsulphate or Turpeth Mineral. Dose, 
gr. ij-v (see Mercuric Preparations). 

ORDER II. CATHARTICS. 

Cathartics (from xadaJpio, I purge) d\so purgatives, are medicines 
which produce evacuations from the bowels. Some operate by 
increasing the peristaltic motion of the intestines ; others stimu- 
late the mucous follicles and exhalants, and occasion watery evacu- 
ations, whence they are termed hydragogues. The more violent of 
the hydragogues, if given in overdoses, produce inflammation of 
the alimentary canal, characterized by violent vomiting and purging, 
abdominal pain and tenderness, cold extremities and sinking pulse. 
From their activity they are denominated drastics. 'Different 
cathartics affect different parts of the alimentary canal unequally, 
some acting more particularly on the upper portion, some on the 
lower, and others affecting all parts equally. 

Cathartics may be arranged in five groups : 1. Laxatives, which 
gently evacuate the contents of the bowels, without causing any 
obvious irritation or affecting the general system. 2. Saline cathartics, 
which increase both the peristaltic action of the bowels and the 
effusion of fluids from the mucous surface, but are devoid of any 



330 MATERIA MEDICA AND THERAPEUTICS. 

excitant action on the general system, and are therefore adapted to 
the treatment of febrile and inflammatory cases, or where, from any 
cause, it is desirable to deplete the vessels of the intestines by the 
abstraction of water. 3. Mild acrid carthartics, which are acrid, but 
not sufficiently violent in their local action to cause inflammation. 
4. Drastics, comprising the more powerful and irritating cathartics, 
which, in large doses, act as acrid poisons. 5. Mercurial 
cathartics. 

Cathartics are employed therapeutically — 1. To evacuate the 
bowels in constipation, and remove noxious matters, as retained 
feces, undigested food, morbid secretions, worms, poison, etc. 2. 
To depurate the blood, as in typhus fever, uremia, etc. 3. To relieve 
inflammation, congestion and plethora, by the depletion of the 
blood-vessels, which results from increased secretion and exhalation 
from the gastro-intestinal canal. 4. To promote absorption. 5. 
To affect remote organs, particularly the brain, through the agency 
of revulsion and counter-irritation. 6. To stimulate the secretion 
of the liver and pancreas, by irritating the orifice of the ductus com- 
munis choledochus. 7. In the treatment of diarrhoea. 8. To relieve 
spasms of the bowels. 9. To restore the catamenia, by the irritat- 
ing influence which they exert on the pelvic vessels. The more 
active cathartics are contraindicated in cases of inflammation or 
ulceration of the gastro-intestinal mucous membrane, peritonitis, 
the advanced stages of typhoid fever, pregnancy, etc. 

The operation of cathartics is promoted by the addition of 
small doses of emetics and of the bitters. By combining those 
which act upon different portions of the alimentary canal, their 
operation is rendered less irritant, without any diminution of 
purgative efficiency. The griping and nauseating tendency of the 
drastic cathartics may be corrected by the addition ofaromatics; 
carbonic acid water is a grateful vehicle for administering the saline 
preparations. Cathartics operate most speedily and favorably when 
given on an empty stomach, and susceptibility to their action is 
diminished during sleep, and increased by exercise. Mild diluent 
beverages promote their operation. In the event of hypercatharsis, 
opium should be admministered by the mouth or the rectum. 

LAXATIVES. 

Several articles of diet have a laxative operation on the bowels, 
and are useful in cases of habitual costiveness, as most of the ripe 



CA THAR TICS— MANNA. 331 

and dried fruits — particularly the tamarind, peach, apple, raisin, fig 
{fiats), and prune (prununi) — West India molasses, honey, bran, 
cracked wheat, Indian meal, and oatmeal. 

The following medicinal substances are usually arranged under 
the head of laxatives, and are employed in cases where we wish to 
open the bowels with the least possible irritation, — as in children 
and pregnant women, in inflammation or surgical operations about 
the abdomen and pelvis, in typhoid fever, hernia, piles, and affections 
of the rectum or womb. 

TAMARINDUS-TAMARIND. 

This is the preserved pulp of the fruit of Tamarindus 
Indica {Nat. Ord. Leguminosae), a large tree of the East Indies, 
cultivated extensively also in the tropical portions of America. It 
comes to the United States chiefly from the West Indies. The 
preserved pods, as found in the shops, consist of a dark-colored 
adhesive mass, formed of pulp, fragments of the pods, seeds and 
syrup, of a sweetish acidulous taste. They contain a good deal of 
citric acid, with some tartaric and a little malic acid. An infusion 
of the pulp sweetened, makes a refrigerant and laxative drink ; Sss-j 
of the pulp is a good laxative. It enters into the confection of senna. 

MANNA. 

Manna is the concrete saccharine exudation, in flakes, of 
Fraxinus Ornus and of Fraxinus rotundifolia {A T at. Ord. Oleaceae), 
small trees of Sicily and southern Italy. 

Preparation and Description. — It is obtained from incisions 
into the stems of the trees. The best kind is produced during the 
height of the season, when the juice flows vigorously, and from 
the upper stems, where it is less fatty. It is called flake-manna, 
or manna cannidata, and consists of pieces from one to six 
inches long, one to two inches wide, and from half an inch to an 
inch thick, of irregular form, but more or less stalactitic, hollowed 
out on one side (from the shape of the tree or substance on which 
they are concreted), of a white or yellowish-white color, an odor 
like that of honey, and a sweet, afterward rather acrid, taste. A 
common manna, called common manna, or manna in sorts, is obtained 
from incisions later in the season, and from the lower stems. It 
occurs in small pieces, which seldom exceed an inch in length, and 
are softer, more viscid and dark than the flake -manna. A still 



332 MATERIA MEDICA AND THERAPEUTICS. 

inferior variety is termed fat manna, and consists of small, soft, 
viscid fragments, of a dirty, yellowish-brown color mixed with a 
few pieces of flake-manna. 

Chemical Constituents. — Manna is soluble in both water 
and alcohol, and contains a white crystalline, saccharine principle, 
termed mannit (C 6 H u 6 ), not susceptible of the alcoholic fermen- 
tation (found also in mushrooms, the olive-tree and other plants), 
fraxin (C 32 H 36 O 20 ), some sugar, and a resin to which it probably owes 
most of its purgative effect. 

Effects and Uses. — In moderate doses manna is nutritive ; in 
larger, mildly laxative. It is given principally to children in consti- 
pation, to whom its sweet taste renders it acceptable ; and it is some- 
times combined with the more active cathartics. It may be taken 
in substance, or dissolved in warm milk or water. Dose for an 
adult, oj-iij; for children, oj-iij. 

VIOLA TRICOLOR. 

Viola tricolor is the wild-grown flowering herb of Viola tri- 
color, Heartsease or Pansy (Nat. 6W.Violaceae), an annual or biennial 
herb, native of Europe and northern Asia, naturalized in the United 
States and cultivated in our gardens. The stem is nearly smooth, 
and grows to the height of one-half to one foot; the leaves are 
alternate, petiolate, ovate or oblong, crenate, and have prominent 
pinnatifid stipules. The flowers are on long peduncles, and have 
the corolla partly yellowish-blue and purple. It is without smell, 
and has a bitter, sub-acrid taste. It contains mucilage, sugar, sal- 
icylic acid, a bitter-principle , resin, etc. 

Effects and Uses. — Heartsease is a mild laxative, sometimes 
proving diuretic and diaphoretic. It is occasionally given as a mild 
laxative to children, but its use is generally restricted to cases of 
acute eczema, and phthiriasis. In these cases it is said to act almost 
like a specific. Piffard* who has used .it extensively, recommends 
an infusion (V. tricolor, oj ; senna leaves, §ss; boiling water, Oij), 
of which a tumblerful may be given twice a day for two or three 
days, after which the dose should be diminished. He finds it par- 
ticularly serviceable in the second stage of eczema, with sero-pur- 
ulent exudation and crusting. The fluid extract (Squibb's) may 
also be given; in acute eczema, dose for a child, Tflj-v once or twice 

* " Materia Med. and Therap. of the Skin," 1881, p. 115. 



CATHARTICS—CASTOR OIL. 333 

daily; in chronic eczema, TTLx-xv ; for an adult the dose is f5ss-j. 
It should be taken in water, half an hour before meals. Sometimes 
it temporarily increases the severity of the eczema, and in these 
cases it should be discontinued for a day or two, or the dose may 
be lessened. 

CASSIA FISTULA. 

This is the fruit of Cassia Fistula or Purging Cassia {Nat. Ord. 
Leguminosae), a large tree of Egypt and the East Indies, now natu- 
ralized in the West Indies and South America. It consists of long, 
woody, dark-brown pods, about an inch in diameter and nearly two 
feet in length, which contain numerous seeds imbedded in a soft 
black pulp. The pulp is the part used, and has a faint nauseous 
odor and a sweet, rather pleasant, mucilaginous taste. It is, in 
small doses, a mild, agreeable laxative, but its chief use is as an 
ingredient in the confection of senna. Dose, 5j to 5j. 

Oleum Olivae (Olive-Oil). The well-known fixed oil obtained 
from the fruit of Olea europaea, or Olive Tree (Nat. Ord. Oleaceae), 
is nutritive, demulcent, emollient, and laxative. It is frequently pre- 
scribed as a constituent of laxative enemata. It is also used as an 
inunction in measles and scarlet fever. 

Oleum Amygdalae Expressum (Expressed Oil of Almond), a fixed 
oil expressed from the Sweet or Bitter Almond, is used for the same 
purposes as olive-oil. 

oleum ricini-castor oil. 

Castor-oil is the fixed oil obtained from the seed of Ricinus 
communis, or Palma Christi (Nat. Ord. Euphorbiacese), a small 
perennial tree of India, now naturalized in many warm climates, and 
cultivated extensively in the United States. In India it attains a 
height of thirty or forty feet, but in this country it is an annual 
plant, about five or six feet in height, with round, thick-jointed, fur- 
rowed stems, of a purplish color above; large peltato-palmate leaves, 
divided into seven or nine segments, on long round footstalks, and 
prickly, three-celled capsules, with a seed in each cell. The seeds 
are ovate, about the size of a small bean, and of a gray color, mar- 
bled with reddish-brown spots and stripes. They consist of a thin 
outer pellicle, an inner hard, blackish shell — both of which are inert 
— and a white oleaginous kernel, which contains the acrid principle. 

Preparation and Chemical Constituents. — Castor-oil is ob- 
tained by expression, by decoction, and by the agency of alcohol. 



334 MATERIA MEDICA AND THERAPEUTICS. 

Fig. 32. 




CASTOR-OIL PLANT. 



FIG. 33. 




1. Castor-Oil Capsule. 

2. Section of Capsule Showing Seeds. 



CATHARTICS— CASTOR OIL. 335 

The first method is the best, and is that which is pursued in this 
country, where large quantities are made, both for home consump- 
tion and exportation; heat should not be employed in preparing it, 
as it renders it rancid. Thus procured, it is nearly colorless, or of 
a pale-yellow color, of a thick, viscid consistence, a faint, unpleasant 
odor, and a mild, nauseous taste, and becomes rancid and thick by 
exposure to the air. It is not soluble in water, but is extremely solu- 
ble in alcohol, readily so in ether, and forms soaps with the alkalies. 
Its composition is not well understood; its constituents would seem 
to be mainly ricinolein (a saponifiable oil resembling olein), ricinic acid, 
palmitin, and an acrid principle. A recent analysis of the stem, root 
and leaves by Beck * yielded volatile oil (non-saponifiable), wax, 
resin, alkalies, and an alkaloid termed ricinine (C 24 H 32 N 7 3 ), identical 
with the alkaloid obtained by Tuson from the seed, and with the 
substance extracted by Wayne, f from the leaves. The latter denies 
its claim to being called an alkaloid. 

Toxicology. — The kernels possess considerable acridity, and 
in large quantities have produced death — the usual symptoms being 
vomiting and purging — and TaylorJ records a case in which the 
eating of twenty of the seeds killed a girl. Christison§ states that 
the seeds will operate as a violent cathartic. Dr. Edson || has, how- 
ever, recently reported sixteen cases of non-fatal poisoning following 
the ingestion of the bean, in none of which did catharsis occur. In 
each instance it was thought three or four were eaten. 

Effects and Uses. — Castor oil is a mild and tolerably certain 
laxative in constipation, operating, when pure, in from four to six 
hours after its administration, without uneasiness in the bowels. It 
does not stimulate the liver nor increase the secretion of bile, but 
purges by a mild irritant action on the intestines (Rutherford \). It 
is admirably adapted to all cases where a free evacuation of the 
bowels is desired, without abdominal irritation, as in acute dysentery, 
pregnancy, typhoid fever, cholera infantum, intestinal colic, enteritis, 
hemorrhoids , proctitis , yellow fever , peritonitis , etc., and is an excellent 
purgative for children. In dysentery or in diarrhoea due to the in- 
digestion of unripe fruit, great benefit is often derived from an emul- 

* Am. Journ. of Pharmacy, Feb., 1888, p. 93. ''Analysis of Ricinus Communis." 

f Ibid., 1874, P- 97- 

% Manual of Med. Jurisprudence, p. 224. 

§ " A Treatise on Poisons," 4th ed., p. 590. 

|| Brooklyn Med. Journ., Feb., 1888, p. 131. 

\ *' Phys. Action of Drugs on Secretion of Bile." 1880. 



336 MATERIA MEDIC A AND THERAPEUTICS. 

sion of oil with laudanum: II Tincturae opii, f 5j ; olei ricini, fSjssj 
pulveris acaciae, oij ; sacchari albi, §ss; aquse cinnamomi,^.^. ad f5iij. 
M. et Sig. — Shake the bottle and take two teaspoonfuls every four 
hours. A similar prescription, modified according to age, will be 
found of service in the summer diarrhoeas of children. The leaves 
are said to possess galactagogue properties, and are applied to the 
breasts, in the form of decoction, to induce the secretion of milk. 

Administration. — For adults the dose is foss-j ; for children, 
f5i-f5ss. To cover its unpleasant flavor it is sometimes taken float- 
ing on spirit, coffee, mint-water, compound spirit of ether, etc., or 
made into an emulsion, or mixed with the froth of porter or a little 
oil of bitter almond. 

Flaxseed Oil and Melted Butter are laxative in the same 
doses as castor- oil. 

SULPHUR. 

Sulphur exists in both kingdoms of nature. It is procured by 
the purification of native sulphur and by the decomposition of the 
native sulphides. The sulphur of commerce is generally obtained 
in the former way, chiefly from Sicily, and is termed crude sulphur. 
It comes also from Romagna, in Italy, and from California, and con- 
siderable deposits of sulphur have been found in the island of Saba, 
one of the Dutch West Indies, and in Japan. 

Preparation. — After importation it is purified by sublimation, 
and is known as sublimed sulphur — sulphur sublimatum. It is 
sometimes sublimed in the form of an impalpable powder, when it 
is called the flowers of sulphur. Sometimes it is cast in wooden 
moulds, and forms the roll-sulphur, or brimstone of commerce. 
Sublimed sulphur contains more or less sulphuric acid, and for 
medicinal use it is further purified by washing, when it constitutes 
the sulphur lotum or washed sidpliur of the Pharmacopoeia. 

Description. — As met with in the shops, it is a fine, bright- 
yellow powder, with a feeble odor and taste, insoluble in water and 
in alcohol, but soluble in alkaline solutions, and the oils ; and when 
perfectly pure it is wholly volatilized by heat, and ought not to 
change the color of litmus-paper. 

Effects and Uses. — In small and repeated doses sulphur is a 
gentle stimulant to the skin and mucous membranes, and in larger 
doses it acts as a mild purgative, without exciting the pulse or occa- 
sioning griping. It is probably absorbed on being converted in the 
small intestine, by the alkali of the bile, into a sulphide. After its 



CA THA R TICS— SULPHUR. 337 

continued use the intestinal gases give off sulphuretted hydrogen. 
Though not classed among the poisons, yet in large amounts (Sij) 
it will produce violent vomiting and purging, raise the temperature, 
and impart to the breath the odor of sulphuretted hydrogen. 

It is employed in the cases to which laxatives are applicable, 
and also as an alterative-diaphoretic in chronic cutaneous diseases, 
and in rheumatism. It is considered a specially useful laxative in 
hemorrhoids. To increase its cathartic effect it is often combined 
with cream of tartar or magnesia. Externally, it is a valuable 
remedy in various skin diseases, particularly the scaly and parasitic, 
as scabies, psoriasis, phthiriasis, favus, and sycosis. In psoriasis, if 
the scales be plentiful, they should be removed with green soap and 
warm water; in favus the hair is to be closely cropped and the 
crusts removed with poultices ; the same preparatory treatment is 
required for sycosis. The strength may be 5j-iv to the 5j of 
ointment. Before its application in scabies the patient should 
thoroughly wash the part with hot water and soft soap. It is also 
used in acne in the form of ointment. 

As a Disinfectant. — Sulphur, when ignited, unites with the 
oxygen of the air to form sulphurous acid gas,, or more correctly, 
sulphurous anhydride. In this state it is powerfully germicidal 
against atmospheric microbes, as has been recently shown in some 
clever experiments by Dubief and Gaillard * For the purpose ol 
disinfecting a contaminated apartment about Sj per cubic yard may 
be ignited in earthen saucers ; all the openings should be tightly 
closed, and the process kept up 24 hours (Dujardin-Beaumetzf). 
To facilitate the burning Pasteur suggests the addition of a little 
alcohol, and to prevent the tarnishing of metal-work vaseline should 
be smeared over it. 

Administration. — Dose, 5j-iij or iv, in syrup, treacle or milk. 
Externally \ it is applied in the form of vapor bath or ointment. 
Unguentum sulphuris consists of 30 parts of sulphur and 70 parts 
of benzoinated lard rubbed together until thoroughly mixed. Ungu- 
entum sulphuris alkalinum [alkaline sulphur ointment) consists of 
sulphur, 20 parts, potassium carbonate, 10 parts, water, 5 parts, 
and benzoinated lard, 65 parts, rubbed together until thoroughly 
mixed. 



* Bull. Gen. de Therap., Aout 30, 1889, p. 175. 
f Therap. Gazette, Feb. 15, 1889, p. 73. 



338 MATERIA MEDICA AND THERAPEUTICS. 

Sulphur Praecipitatum {Precipitated Sulphur, or Lac Sulphur is) 
is prepared by boiling together sulphur, slaked lime and water and 
afterward precipitating the sulphur by hydrochloric acid. It is a 
finer and softer powder than sublimed sulphur, is of a paler yellow 
color, with a grayish tint, and is not often gritty between the teeth. 
When exposed to the air, however, it is liable to become contami- 
nated with sulphuric acid, and, as found in commerce, it is often 
adulterated with calcium sulphate. Its effects, uses, and doses are 
the same as those of sublimed sulphur. 

Potassa Sulphurata {Sulphurated Potass a), or Liver of Sulphur, 
is prepared by rubbing together one part of sublimed sulphur with 
two parts of potassium carbonate, afterward melting the mixture, 
and pouring it when cold into a bottle. Its composition is variable 
and uncertain, but it should contain about 50 percent, of potassium 
sulphide. When freshly and carefully prepared it is of a liver color, 
has an acrid, alkaline, disagreeable taste, and forms an orange -yellow 
solution with water. This preparation and the other sulphides 
probably act like sulphur. They are, perhaps, in part decomposed 
by the acids of the stomach, but any liberated sulphur must be again 
combined with the alkali of the bile. 

Toxicology. — Taken in large quantities sulphurated potassa is a 
corrosive poison, capable of producing fatal gastro-enteric inflam- 
mation. Three cases of poison are reported from it by Orfila* in 
one of which 5iij, proved fatal. 

Medicinal Uses. — The sulphides are considered to be expecto- 
rant, diaphoretic, and alterative. They have been especially recom- 
mended in the scrofulous abscesses of children — the calcium sulphide 
being preferred. Dose, for an adult, gr. ij-x, several times a day. 
They are used externally in scaly skin diseases in the form of oint- 
ment (5ss to 5J of lard), and of baths. 

SULPHUR-WATERS— NORTH AMERICAN. 

Blount Springs {Blount County, Alabama). — This water, ana- 
lyzed by Prof. R. Brumby, contains magnesium, calcium, and iron 
carbonates, sodium chloride, with carbonic acid and sulphuretted 
hydrogen. It is a saline sulphur-water. 

Alpena Well {Alpena County, Michigan). — Contains the alkaline, 
earthy, and iron carbonates with an abundance of sulphuretted hy- 
drogen. 

* " Toxicologic Generate,' ' Vol. i, p. 177. 



CATHARTICS—SULPHUR WATERS. 339 

Sharon Springs [Schoharie County, New York). — *These waters 
contain sodium, magnesium, and calcium- chlorides, the alkaline and 
earthy carbonates, and in small proportion sodium and calcium sul- 
phides and sulphuretted hydrogen. 

Richfield Springs {Otsego County, Neiv York). — Prof. Reid's 
analysis shows these waters to contain magnesium and lime carbon- 
ates, Epsom salt, calcium sulphate, and sulphuretted hydrogen. 
May be taken two to four glasses daily; also as baths. 

Minnequa Springs [Bradford County, Pennsylvania). — Contains 
sodium, magnesium, and lime carbonates, iron oxide and an unde- 
termined quantity of sulphuretted hydrogen. It is a chalybeate 
sulphur-water. 

Jordan's White Sulphur Springs [Frederick County, Virginia). — 
They contain the earthy, alkaline, and iron carbonates in small pro- 
portion with sulphuretted hydrogen. May be taken freely. 

Greenbrier While Sulphur Springs [Greenbrier County, West Vir- 
ginia). — They contain the earthy and alkaline carbonates and chlo- 
rides, Epsom salt, calcium sulphate, silicates, and the following 
gases : carbonic acid, sulphuretted hydrogen, oxygen and nitrogen. 
An excellent aperient alterative water with a diuretic action. 

SULPHUR-WATERS-EUROPEAN. 

Aix-la-Chapelle [Rhenish Prussia). — Analyzed by Liebig; tem- 
perature 1 3 1 ° Fahr. Contains the alkaline, earthy and iron car- 
bonates, sodium chloride in considerable quantity, Glauber's salt, 
sodium iodide and bromide, with carbonic acid, sulphuretted hydro- 
gen, and nitrogen gases. The Nenndorf and Meinberg wells are 
very similar in composition, but in temperature they are about 8o° 
lower. These waters possess an alkaline, saline and sulphurous 
taste, and are diaphoretic and diuretic. 

Aix-les-Bains (Savoy). — Analyzed by Bonjean. The eau de 
soufre has a temp, of 108-11 Fahr., contains the alkaline, earthy, 
and iron carbonates with traces of the sulphates, and carbonic acid, 
nitrogen, and sulphuretted hydrogen gases. They are employed 
mostly as baths. The springs at Bareges, and Bagneres de Luchon, 
in France, are very similar in composition except as to tempera- 
ture, the former being 64 ° Fahr., the latter 1 3 1 ° Fahr. 

Medicinal Uses. — The characteristic of the sulphur waters is 
the odor of sulphuretted hydrogen. The composition and effects 
vary according to the preponderance of certain ingredients. Those 



340 MATERIA MEDIC A AND THERAPEUTICS. 

that contains goodly proportion of common salt are termed saline- 
sulphur ; when they have a large quantity of calcic salts they are 
constipating. Some are sedative, others exciting, particularly those 
of high temperature. They all are diaphoretic and diuretic. These 
waters are prescribed internally and externally in various cutaneous 
affections, as chronic eczema, lichen, psoriasis, phthiriasis, and syphi- 
litic eruptions. The warm sulphur baths are beneficial in gout and 
chronic rheumatism, colica Pictonum, hepatic engorgement, and hem- 
orrhoids. 

SALINE CATHARTICS. 

Before considering in detail the precise action on the alimentary 
tract of the saline cathartics, a brief argument will be offered relating* 
to the opinions and work of the investigators who have experimented 
physiologically with these substances. There has been much con- 
troversy between numerous investigators as to their exact method 
of action upon the intestinal canal, the question being this : Do they 
effect catharsis, by inciting peristalsis ; or is it due to an increased 
discharge of fluids ? Considerable practical evidence has been 
brought forward by Thiry and Radziejewsky to prove that cathartic 
drugs, especially the drastics, operate by arousing peristalsis, but 
their work, though apparently accurate, lacks the confirmation of 
observers whose results cannot be impugned, and, moreover, the 
latter have much clinical evidence to substantiate their side of the 
question. Among those who have devoted largely of time and 
labor in the laboratory to the elucidation of the action of the salines 
are Lauder Brunton,* Anstie,f Moreau,| Matthew Hay § and Vul- 
pian.|| The work of Hay, with which we agree, is most elaborate, 
being a model of research. Concisely stated, all of these observers 
are unanimously of the opinion that catharsis is induced chiefly by 
augmented intestinal secretion, and they offer many incontroverti- 
ble facts to substantiate their opinions. We quote some of Hay's 
conclusions : 



* Practitioner, Vol. XII, pp. 342 and 403. ,( On the Actions of Purgative Medicines." 

"f" Med. Times and Gazette, Vol. I, pp. 326 and 487. '' Report on the Action of Podo- 
phyllin." 

% Arch. Gen. de Med., xvi. &eme se r., p. 234. " L'action du sulphate de magnesie 
sur l'intestin." 

\T ourn - of Anat. and P/iys., Vol. XVI, pp. 343, 391 ; Vol. XVII, pp. 62,223, 4^5» ''The 
Action of Saline Cathartics." 

II Gazette Medicate de Paris, 1873, P- 3°°- 



SALINE CATHARTICS. 341 

"A saline purgative always excites more or less secretion from 
the alimentary canal, depending on the amount of the salt and the 
strength of its solution, and varying with the nature of the salt. 
The excito-secretory action of the salt is probably due to the bitter- 
ness as well as to the irritant and specific properties of the salt, and 
not to osmosis. The low diffusibility of the salt impedes the ab- 
sorption of the secreted fluid. Purgation will not ensue if water 
be withheld from the diet for one or two days previous to the ad- 
ministration of the salt in a concentrated form. C ceteris pari fois, the 
weaker, or, in other words, the more voluminous the solution of the 
salt administered is, the more quickly* is the maximum within the 
canal reached and accordingly purgation follows with greater rapidity. 

" The salt excites an active secretion in the intestines, and 
probably for the most part in the small intestine, all portions of this 
viscus being capable of yielding the secretion in almost equal quan- 
tities. The bile and pancreatic juice participate but very little in the 
secretion. The salt does not purge when injected into the blood, 
and excites no intestinal secretion. Nor does it purge when injected 
subcutaneously, unless in virtue of its causing local irritation of the 
subcutaneous tissue, which acts reflexly on the intestines, dilating 
their blood-vessels, and perhaps stimulating their muscular move- 
ments. The sulphate of soda exhibits no poisonous action when 
injected into the circulation. The sulphate of magnesia is, on the 
other hand, powerfully toxic when so injected, paralyzing first the 
respiration and afterward the heart. Both salts, when administered 
in the usual manner, produce a gradual but well-marked increase in 
the tension of the pulse. The blood recoups itself in a short time 
by absorbing from the tissues a nearly equal quantity of their fluids. 
The salt after some time causes diuresis. The amount of the nor- 
mal constituents of the urine is not affected by the salt. The salt 
has no specific action in lowering the internal temperature of the 
body." 

Lauder Brunton (loc. cit.) differs from Hay's (loc. cit.) conclu- 
sions in that he found that purgatives reduced the arterial pressure, 
as shown by the sphygmograph. 

Clinically, the results of these observers are supported by the 
fact that watery stools are characteristic of the exhibition of the 
salines in sufficient doses. 



342 MATERIA MEDIC A AND THERAPEUTICS. 

MAGNESIA— MAGNESIA. 
MAGNESIA PONDEROSA— HEAVY MAGNESIA. 

Magnesia (MgO), sometimes called calcined magnesia, from the 
mode in which it is prepared, is procured by exposing magnesium 
carbonate to a red heat, till the carbonic acid is wholly expelled. 
It is a light, fine, white, colorless, odorless powder, of a feeble, 
earthy taste, very slightly soluble in water, and more soluble in cold 
than in hot water. Heavy magnesia is a white, fine, dense powder, 
chemically identical with magnesia and differing from it only in the 
degree of aggregation of their molecules. Henry s Magnesia, a 
patent English medicine, has the advantage over the ordinary mag- 
nesia of greater density and softness, and more ready miscibility 
with water, and corresponds to the official magnesia ponderosa. 
Magnesia prepared by Husband, and Ellis, of Philadelphia, is very 
similar in properties to Henry's. 

Effects and Uses. — Magnesia is antacid and laxative. A good 
deal of its cathartic effect is in part the result of its combination 
with the free acids of the stomach and intestines, but also of the 
excretion and pouring out of fluid into the intestines. When taken 
in large quantities, and for too long a period, it sometimes accumu- 
lates in the bowels ; and hence it is best to increase its solubility 
by giving it with lemonade. 

It is an excellent laxative where much acidity exists in the 
stomach, and is particularly useful in infantile cases. As an antacid 
and laxative it is employed in heartburn, sick headache, biliousness 
and duodenal catarrh. Dose, as a laxative, 5j ; as an antacid, gr. xx, 
in water or milk. Of Henry's, half the quantity. 

MAGNESII CARBONAS -MAGNESIUM CARBONATE. 

Magnesium carbonate, sometimes called magnesia alba, is pre- 
pared by decomposing magnesium sulphate with an alkaline car- 
bonate. As found in the shops it is a combination of magnesium 
carbonate and magnesium hydrate (4MgC03.Mg2HO.5H2O). It 
occurs in the form of light, white, cubical cakes or powder ; is in- 
odorous, almost insipid, and nearly insoluble in water, but soluble 
in carbonic acid water. 

Effects and Uses. — These are nearly the same as those of 
calcined magnesia ; but from its effervescence with the acids of the 
stomach, it is apt to create flatulence, though sometimes, on this 



• CATHARTICS— MAGNESIUM SULPHATE. 343 

account, it is more acceptable to delicate stomachs. Dose, as a 
laxative, 5j-ij ; as an antacid, gr. x. 

MAGNESII SULPHAS— MAGNESIUM SULPHATE. 

This salt (MgS0 4 .7H 2 0), commonly called Epsom Salt, from its 
having been first procured from the Epsom mineral water in Eng- 
land, occurs in native crystals, and is a constituent of sea-water and 
many saline springs. It is obtained in England from dolomite, or 
magnesian limestone ; and also from bittern, or the residual liquor 
of sea-water, from which common salt has been separated. In this 
country it is extensively manufactured at Baltimore and Phila- 
delphia, by the action of sulphuric acid on magnesite, the silicious 
magnesium hydrate. It is usually met with in small acicular crys- 
tals, which are colorless, transparent and odorless, but have an 
extremely bitter taste. They effloresce on exposure to the air, are 
very soluble in water, and insoluble in alcohol. 

Effects and Uses. — Epsom salt is a mild, safe, refrigerant pur- 
gative, which, from its cheapness, is by far the most commonly 
employed of all cathartics. It produces free, watery purgation, with 
very little irritation of the intestines, stimulating the intestinal 
glands, but not affecting the liver. By reason of these effects it is 
very serviceable in conditions of congestion, inflammation, cerebral 
hyperemia, etc. 

Matthew Hay* has called attention to the efficacy of concen- 
trated saline cathartics for the removal of dropsical effusions, as in 
pleurisy, hydrothorax and pericarditis. He states that they concen- 
trate the blood, increase the proportion of red globules, and produce 
watery stools. He used of Epsom salt 5^ to water foj. Oslerf 
reports favorable results with Hay's method in diminishing pleuritic 
effusions. He employed 5iv-vj to water §j. The stomach should 
be empty at the time of administration and the patient should not 
drink for some time afterward. In the treatment oi colic a Pictonum 
and the cachexia resulting from chronic lead-poisoning, this salt, 
combined with diluted sulphuric acid, is of the greatest service. 
It is also used in combination with opium in acute dysentery, but is 
inferior to Rochelle salts in the treatment of this complaint. It is 
sometimes combined with senna, sometimes with bitter infusions, 



* Lancet, April, 1883, p. 678. f The Med. News, Dec , i836, p. 645. 



344 MATERIA MEDIC A AND THERAPEUTICS. 

and is most agreeably administered in solution in carbonic acid 
water. Dose, Sss-j. 

LIQUOR MAGNESII CITRATIS— SOLUTION OF MAGNESIUM CITRATE. 

Under this name magnesium citrate is employed in solution, 
with slight excess of acid, and in the effervescing state. It is pre- 
pared according to the following formula : citric acid, gr. 400 are 
dissolved in water gr. 2000, and in this solution magnesium carbon- 
ate gr. 200 are stirred until dissolved ; this solution is filtered into 
a strong twelve-ounce bottle, containing syrup of citric acid gr. 
1200; to this is added water, previously boiled and filtered enough 
to nearly fill the bottle ; potassium bicarbonate gr. xxx are then 
dropped in and the bottle is immediately closed with a cork, and 
secured with twine ; the mixture must be occasionally shaken to 
insure the solution of the bicarbonate. The effervescing solution 
has a pleasant acid taste, without anything disagreeable. It is a very 
grateful cathartic, and is much employed as a substitute for Epsom 
salt, but is more apt to produce slight griping. Dose, from a half 
to a whole bottle. 

Magnesii Citras Granulatus {Granulated Magnesium Citrate) is a 
white, coarsely-granular salt, deliquescent on exposure to air, odor- 
less, having a mildly acidulous, refreshing taste, and an acid reaction. 
Soluble with copious effervescence in two parts of water; almost in- 
soluble in alcohol. It should be kept in closely-stoppered bottles. 
Its effects are similar to those of the solution, and it is used for the 
same purpose. It has the advantage of portability. Dose, 5j-iv 
dissolved in water and taken while effervescing. 

SODII SULPHAS— SODIUM-SULPHATE. 

Sodium sulphate, commonly called Glaubers Salt (Na 2 S0 4 .io 
H 2 0), is a constituent of many mineral springs, and is prepared in 
various chemical processes. It occurs as a residuum in the, manufact- 
ure of hydrochloric acid, made by adding sulphuric acid to sodium 
chloride, and it is obtained from sea-water in the winter season. It 
is found in colorless, six-sided, very efflorescent crystals, which are 
inodorous, but have a cooling, saline, very bitter taste. It is soluble 
in water, more readily in hot than cold water — and is insoluble in 
alcohol. 

Effects and Uses. — These are very similar to those of Epsom 
salt, but it is more bitter and nauseous, and is now little used. It 



CA THA R TICS— SODIUM PHOSPHA TE. 345 

is a mild hepatic stimulant, according to the experiments of Ruther- 
ford on dogs. The effects of the sodium salts have already been 
considered (vide index). It has an anaplastic action on the blood, 
due to the sodium which it contains. Dose, Sj ; in an effloresced 
state, Sss. 

MANGANI SULPHAS— MAGANESE SULPHATE. 

This salt (MnS0 4 .4H 2 0) is made by heating the native black 
oxide with concentrated sulphuric acid. It occurs in rhombic, pris- 
matic crystals, of a pale-rose or pink color, transparent, and of an 
astringent and bitterish taste. It is very soluble in water, insoluble 
in alcohol. 

Effects and Use. — These are said to resemble Glauber s Salt, 
acting also as a cholagogue. Dose, as a purgative, 5j-ij- As a 
tonic (vide p. 175) it has been given in doses of gr. v-xx. 

SODII PHOSPHAS— SODIUM PHOSPHATE. 

The salt is prepared by digesting burnt bone with diluted sul- 
phuric acid, and decomposing the resulting monocalcic phosphate 
with sodium carbonate. It is disodic phosphate, and occurs in large 
rhombic, colorless, transparent, very efflorescent crystals (Na 2 HP0 4 . 
I2H 2 Q), which are w 7 holly soluble in water and insoluble in alcohol, 
and have a pleasant saline taste, resembling common salt. 

Effects and Uses. — Sodium phosphate is a mild saline ca- 
thartic, well adapted, from its agreeable taste, to the cases of children 
and delicate persons. It is an hepatic stimulant, increasing the 
amount of bile secreted, although making it more watery, and having 
a very slight irritant action on the intestinal mucous membrane 
(Rutherford). It increases the alkalinity of the blood and dimin- 
ishes the amount of urea excreted. It is a constituent of the blood 
in health, and has been recommended in cholera as a restorative of 
deficient saline matters, to repair the drain on the system caused by 
chronic suppurations, and also in diseases where there is a deficiency 
of phosphatic matter in the bones, as in rickets. In all catarrhal 
conditions of the gastro-intestinal mucous membrane, notably in 
catarrhal jaundice, sodium phosphate is of the greatest utility, and 
it is one of the agents used to promote the solution of gall-stones in 
the dose of 3j t. d. in water, taken before meals and continued 
several weeks. It is highly recommended also in chronic infantile 
diarrhoea with pasty stools (Routh). Dr. Peters* advises the em- 

*JV. Y. Med. Record, Jan. 23, 1886. 



346 MATERIA MEDIC A AND THERAPEUTICS. 

ployment of sodium phosphate in chronic rheumatism for the rea- 
sons, that, in addition to its laxative action, it lessens the gastro- 
intestinal acidity, and makes the blood, urine, and perspiration 
more alkaline. 

Administration. — Dose, as a cathartic, 5yj, in broth or soup. 
As an alterative, gr. xx-5j, three or four times a day. 

Sodii Pyrophosphas [Sodium Pyrophosphate) (Na 4 P 2 7 .loH 2 0) 
occurs in colorless, translucent prisms, odorless, but having a cool- 
ing, saline taste, and a slightly alkaline reaction. The effects and 
uses are said to resemble those of sodium phosphate. Dose 5ss-iv. 

POTASSII SULPHAS POTASSIUM SULPHATE. 

This salt exists in both kingdoms of nature, and is obtained 
artificially from the residuum of the distillation of nitric acid from 
potassium nitrate and sulphuric acid. It occurs in small, hard, 
colorless, inodorous crystals (K 2 S0 4 ), of a saline, bitter taste, which 
have no water of crystallization, and are unalterable in the air. They 
are moderately soluble in water, and are insoluble in alcohol. 

Effects and Uses. — The physiological effects of the potassium 
salts have already been fully considered {vide p. 253). In small 
doses it is considered a mild and safe cathartic ; but in large doses 
has proved a violent and even fatal poison producing symptoms 
of cholera. It is thought to act as a galactifuge ', and is administered 
with this view in France. Dose, as a cathartic, gr. xv-5j-ij ; but it 
is little employed in this country. From its hardness and dryness 
it is useful to promote the trituration and division of powders. 

POTASSII BITARTRAS POTASSIUM BITARTRATE. 

This salt, well known as Cream of Tartar, and termed also acid 
potassium tartrate, is the monopotassic tartrate (KHQH^Og). It 
exists in many vegetable juices, particularly the juice of grapes, 
from which it is obtained. 

Preparation and Description. - It is deposited in an impure 
form, during fermentation, on the sides of wine-casks, and in this 
state occurs in crystalline cakes, of a reddish color, known as argol 
or crude tartar. This is purified by solution and crystallization, and 
forms a white crystalline mass or powder, termed cream of tartar. 
It is without smell, has an acidulous and gritty taste, is very slightly 
soluble in water, and insoluble in alcohol ; when heated in a close 
vessel, it is converted into black flux, a compound of charcoal and 
potassium carbonate. 



CATHARTICS— POTASSIUM AND SODIUM TARTRATE. 347 

Effects and Uses. — In small doses it is diuretic and refrigerant ; 
in larger doses, cathartic; and in excessive doses it will produce 
gastro-intestinal inflammation. It is employed to forma refrigerant 
drink, and as a gentle aperient in fevers ; as a diuretic and hydra- 
gogue cathartic in general dropsy depending on valvular disease of 
the heart, and in acute B right's disease. 

Administration. — Dose, as an aperient, 5ss-j ; as a cathartic, 
§ss-j ; as a diuretic, gr. x-5j, in repeated doses. It enters into the 
compound powder of jalap. 

POTASSII TARTRAS POTASSIUM TARTRATE. 

This salt, formerly called Soluble Tartar, is obtained by satu- 
rating the excess of acid in cream of tartar with potassium carbo- 
nate, and is dipotassic tartrate (2K 2 QH 4 6 .H 2 0). It occurs in white 
deliquescent crystals or grains, of a saline, somewhat bitter taste, 
and is very soluble in water. It is a gentle cathartic and diuretic, 
at present not much used. Dose, 5ss to j. 

POTASSII ETSODII TARTRAS POTASSIUM AND SODIUM TARTRATE. 

This salt (KNaQH 4 6 4H 2 0), commonly called Rochelle Salt, 
is made by saturating the excess of acid in cream of tartar with 
sodium carbonate. It occurs in large, transparent, colorless, pris- 
matic, slightly efflorescent crystals, of a mildly saline and bitter 
taste, readily soluble in cold water, and still more so in hot water. 

Medicinal Uses. — It is the best saline for use in the treatment 
of acute dysentery, combined with opium and given in small doses 
frequently repeated until 5j has been taken in the first 24 hours, after 
which the dose is decreased. 1^ Potassii et sodii tartratis, 5j ; 
tincturae opii, Tft x; aquae, f§ss. M. S. — Every two hours. It is a 
mild and pleasant aperient, well adapted to gouty cases and cases of 
uric acid diathesis, but it renders the urine alkaline, and should not 
therefore be given to persons suffering with phosphatic deposits in 
the urine. 

Administration. — Dose, §ss-j. It is usually exhibited in the 
form of pidvis effervescens compositus {compound effervescing powder), 
or Seidlitz poivder, which consists of Rochelle salt (3'j) and sodium 
bicarbonate (gr. xl) in a blue paper, and tartaric acid (gr. xxxv) in a 
white paper. They are taken, dissolved in half a pint of water, while 
the liquid is in a state of effervescence, and form a very agreeable 
mild aperient in bdiousness, migraine, etc., and are very acceptable 
to the stomach. They should not be kept in a damp place. 



348 MATERIA MEDIC A AND THERAPELTICS. 



SALINE MINERAL WATERS— NORTH AMERICAN. 

St. Catharine's "Wells (St. Catharine's, Ontario, Canada). An- 
alysis of Stephenson House Well by Prof. Croft : one pint con- 
tains potassium chloride, gr. 2.587; sodium chloride, 217.234; 
magnesium chloride, 24.760; calcium chloride, 108.271; ammonium 
chloride and silicic acid, 0.056; calcium sulphate, 15.981; magnesium 
iodide, 0.030 ; magnesium bromide, 0.045 \ temperature, 6o° F. For 
internal use they must be diluted }&—% with ordinary water. They 
are employed also in the form of water-baths. These waters have 
been found beneficial and curative in chronic rheumatism, gout and 
scrofula. 

Michigan Congress Spring (Ingham County, Michigan^). Anal- 
ysis by Dr. Jennings : one pint contains sodium carbonate, gr. 8.094 ; 
magnesium carbonate, 1.42 1 ; iron carbonate, 0.143 ; lime carbonate, 
7.782; sodium chloride, 33.349; potassium sulphate, 1.554 ; sodium 
sulphate, 3. 131 ; silica, 0.413 ; carbonic acid gas, 24^ cubic inches ; 
temperature, 53^° F. An alkaline-saline water, decidedly purga- 
tive in character; in moderate quantities is only diuretic. It is 
applicable to the treatment of dyspepsia with plethora, obesity, chronic 
hepatitis and gall-stones. 

Saratoga Waters. From the analysis of these waters (see p. 
349) it will be seen that they consist chiefly of sodium chloride and 
the alkaline carbonates. Containing so large a proportion of alkali, 
they may be termed alkaline-saline waters. Besides this they are 
highly impregnated with carbonic acid gas, rendering them palatable 
and easy of digestion. Their use is adapted to cases of dyspepsia de- 
pending on high living, and an engorged condition of the liver ; in 
acidity, also in jaundice, due to catarrh of the biliary ducts. Since 
these waters contain the salines in abundance they are of a purgative 
nature, and hence may be useful in habitual constipation, obesity and 
plethora of the abdomi?ial viscera. As most of them have a small pro- 
portion of lithium carbonate, particularly the Pavilion Spring, they 
often prove beneficial in gout and the gouty diathesis. The Colum- 
bian, Hamilton, Excelsior and Eureka Springs contain iron carbon- 
ate (about gr. ^ to the pint), and are consequently adapted to anemic 
cases ; they are to be drunk cautiously by the plethoric. The dose of 
the Saratoga waters is, as ^cathartic, two or three glasses taken leis- 
urely before breakfast ; then a walk of ten or fifteen minutes and an- 



CATHARTICS— SALINE MINERAL WATERS. 



349 



other glass or two ; breakfast half ah hour later. As an alterative 
one glass three or four times daily. The waters of the springs that 
contain iron should be taken one-quarter to one glass per diem. 



Analysis of Saratoga Springs; Saratoga County, New York. 



One Pint Contains — 



•jz m'o U ^u X ;j 

H 8 8 

£ £ £ 



Solids. 

Sodium carbonate . . 
Magnesium carbonate 
Iron carbonate . . . 
Calcium carbonate . 
Lithium carbonate . 
Strontium carbonate 
Barium carbonate . . 
Potassium chloride . 
Sodium chloride . . . 
Potassium sulphate . 
Sodium sulphate . . 
Magnesium sulphate 
Sodium phosphate . 
Calcium phosphate . 
Sodium iodide . . . 
Sodium bromide . . 
Calcium fluoride . . 
Sodium biborate . . 

Alumina 

Potassium silicate . . 
Sodium silicate . . . 

Silica 

Organic matter . . . 



grs. grs. 



grs. 



3.024 
4.069 
0.135 

n-443 
0.154 

trace 
o 050 
1. 122 

48.766 



o-934 
9.019 
0.031 
12 449 

0-374 
trace 
0.095 

1.006 



0.372 
13.072 

0.101 
14,815 



trace 






Q 
eg 



mU grtU jji3u £llo 

"Sfc .TJ^fci^ofa £0 



RJ 



grs. I 

I-336 
3 461 
0.698 
8.500 



grs. J 

0.782 

3.182 

0.079 

9.520 

0.163 

trace j trace . . . 

0.178' 0.008 . . . 

1.199; °-53° • • • 

63 746; 63.328 33.375 

• 0.346 ... 1 



grs. 



grs. 



trace 0.002 oo.oi 



o.dii o 017 0.025 

0.091 1.069 0.192 

trace ' trace trace 

trace trace . . . 

0.153 trace 0.016 



0.283 0.105; 0.157 
trace trace trace 



Total 



Gas. 
Carbonic acid 



[69.502 75.267J 93.874 
cub. in cub. in cub. in 

j 5i 49 I 47 

(1866) (1871) 



0.003 



o.oor 
0-033 
trace 
trace 
o 052 



0.405 2.552 

5.399 2.988 

0.065 °- r 55 

8.084 7-804 

0.380 0.071 

0.001 trace 

0.094 trace 

1. 0781 0.167 

^7-734 16.786 

. . . 0.069 



>'J 






.5 a 



Q 



w 



grs. 

6-175 
10.322 
0.089 
14-793 
0-549 
0.041 
0.206 

3079 

70.260 
trace 



1.097 
4586 
0.110 

10. 795; 

0.124 

trace 
0.010! 
1. 2121 
49-795 
0.675 



« = 
%< 



W^ X 
X 



grs. grs. j grs. grs 

1. 107 0.625; 1.875 4.281 

2.618 3.667: 4.042 4.883 

0-375 1 0.402 0.578 

5.165 9.625 12.249 



7-324 
0.016 



0.686, . . . I . . . I . . . 
8.699' 20.852 46.330 37.332 



,l6<5 



Kb 



1. 212 

5.568 
0.185 
8.845 

f-339 
trace 

0.074 

1.040 
42 058 

0.269 



...... ... I ...... I 0.268: 



o 002 trace trace trace 



trace 
trace 



0.182 
trace 



0.320 0.006 0.004 
. . . 0.106' 0.079 j 
. . . j trace trace 
. . . trace trace 
. . . I 0.012 0.047 



0.031 
0.276 
trace 
trace 
trace 



0.015 
0.071 
trace 
trace 
trace 



0.583 0.529 0.449 
0.196 . . 



O.OOJ 



0.256 0.398 0.320 
. . . trace trace 



0.013 
trace 



0.160 
trace 



'o 219 0.029 j 

I 0.875 - • ■ : 

0.500 . . . 
0.339 0-067 • • ■ 2 o.i25: 



o 008 
0.051 
trace 
trace 
0.038 



78.215 47.946 33.764 31.042 105.834 68.650 21 008 31.^27 
cub. in cub. in cub. in cub. in cub. in cub. in cub. in cub. in 

43 ! 34 30 40 



57 
(1870) 



5o 



29 



0.401 
trace 



64-343 59-897,60.089 
cub. in cub. in cub. in 

31 40 ' 39 

(1870, 



1 Alumina and ferric oxide. 



2 Silica and alumina. 



Caledonia Springs (Prescott County, Ontario, Canada). One pint 
of the Saline spring, analyst, T. S. Hunt, contains : sodium car- 
bonate, gr, 1.284; magnesium carbonate, 3.769; iron carbonate 
trace ; calcium carbonate, .856 ; manganesium carbonate, trace ; 
potassium chloride, .219; sodium chloride, 46.934; potassium sul- 
phate, .035 ; sodium iodide, .010; sodium bromide, .123 ; alumina, 
trace; silica, .309; total solids, 53.539; carbonic acid gas, 4 cubic 
inches; flow per minute, 10 gallons; temperature, 45 ° Fahr. This 
water is alkaline in reaction ; valuable in gout, chronic rheumatism, 
obesity and scrofula. 



350 MATERIA MEDICA AND THERAPEUTICS. 

SALINE MINERAL WATERS-EUROPEAN. 

Homburg {Germany, near Frankfort). Elizabeth Brunnen ; ana- 
lyst, Liebig; temperature, 50 Fahr. One pint contains magnesium 
carbonate, gr. 2.01 ; iron carbonate, 046 ; calcium carbonate, 1099; 
sodium chloride, 79.15 ; magnesium chloride, 7.79; calcium chlor- 
ide, 'j.yy ; sodium sulphate, 0.38; silica, 0.32 ; total solids, 108.87 5 
carbonic acid gas, 44.46 cubic inches. These waters are strongly 
saline and contain a fair proportion of iron. Homburg, a small 
village, is situated on the slope of a hill at the eastern extremity of 
the Taunus. There are five springs found here. Their waters are 
beneficial in dyspepsia with anemia, obesity, habitual constipation, con- 
ditions of plethora, hepatic engorgement, etc. 

Kissingen [Bavaria). Ragoczi ; analyst, Liebig ; temperature, 
51 Fahr. One pint contains iron carbonate, gr. 0.24; calcium 
carbonate, 8.14; potassium chloride, 2.20; sodium chloride, 44.71 ; 
magnesium chloride, 2.33 ; lithium chloride, 0.15 ; magnesium sul- 
phate, 4.50; calcium sulphate, 2.99; calcium phosphate, 0.04; 
sodium iodide, trace ; sodium bromide, o 06; sodium nitrate, 0.07 ; 
silica, 0.09; total solids, 65.52; carbonic acid gas, 41.77 cubic 
inches; ammonia, 0.007. Kissingen is situated in a salubrious 
valley on the river Saal. Its waters are adapted to catarrhal dys- 
pepsia with constipation and anemia. In gout accompanied by 
plethora, these waters are often extremely beneficial. Being cold 
and very saline they are not adapted to gastric maladies with 
inflammation. 

Wiesbaden [Germany, Duchy of Nassau). Analyst, Fresenius; 
Kochbrunnen ; temperature, 15 5. 75° Fahr. One pint contains 
magnesium carbonate, gr. 0.08 ; iron carbonate, 0.04 ; manganesium 
carbonate, 0.604: calcium carbonate, 3.21; potassium chloride, 
1. 12; sodium chloride, 52.50; magnesium chloride, 1.57; calcium 
chloride, 3.62; ammonium chloride, 0.13; lithium chloride, 0.001 ; 
calcium sulphate, 0.69 ; calcium phosphate, 0.003 J sodium bromide, 
0.003 5 calcium arseniate, 0.00 1 ; aluminum silicate, 0.004; silica, 
046; total solids. 63.463 ; carbonic acid gas, 16.7; nitrogen, 0.10. 
This resort is situated in a valley on the southerly exposure of the 
Taunus. Its ' climate is temperate. At Wiesbaden there are 
twenty-nine springs that furnish a supply of hot water, which is 
used for bathing in every form. In the dose of a pint these waters 
increase the salivary flow, produce a sense of gastric warmth, and 



CATHARTICS— SALINE MINERAL WATERS. 351 

cause a moderate alvine evacuation. In doses of 3 pints to a quart 
they purge freely. They increase the amount of urine, and more 
uric acid and urea is eliminated. The pulse is quickened, diapho- 
resis induced, and the feces made semi-fluid. The Wiesbaden 
waters are particularly beneficial in gout and chronic rheumatism 
without inflammatory symptoms, and the uric acid diathesis. They 
are also employed in facial neuralgia and paralysis with advantage. 

Bourbonne {France), and Seltzer, {Duchy of Nassau, Ger- 
many) furnish saline waters in common use. The former is mildly 
laxative ; the latter cool, refreshing, and slightly alkaline ; it is 
employed as a table drink under the name Seltzer-Water. 

Baden-Baden. These are thermo-saline; temperature, 155 
Fahr., and contain sodium, chloride gr. xvi to the pint. Used 
chiefly for bathing purposes. 

Piiiina {Bohemia), furnishes a strong purgative water, consist- 
ing principally of sodium, gr. 124, and magnesium sulphate, gr. 93 
to the pint. 

Friedrickshall {near Coburg, Germany), yields a purgative 
bitter-water. It contains sodium and magnesium sulphates but in 
less quantity than the Piillna water. It is largely bottled for ex- 
portation, and employed in constipation, diabetes mellitus, gastric 
catarrh and renal calculi (Sprudel Spring). 

Carlsbad {Bohemia) produces an alkaline-saline water, tem- 
perature 162 Fahr. Its two largest ingredients are sodium car- 
bonate gr. ix, and sulphate gr. xx to the pint. This water is 
pre-eminently useful in hepatic affections as jaundice ; also in gout, 
renal calculi, gastric catarrh, chronic rheumatism, constipation, the uric 
acid diathesis, acidity, diabetes mellitus and obesity. 

Marienbad {Bohemia), similar to Carlsbad, except that they 
contain more sodium sulphate, carbonic acid and iron. The tem- 
perature is 53 Fahr. 

Hunyadi Janos {Buda-Pesth, Hungary). Analyst, Bunsen ; one 
pint contains chiefly sodium carbonate, gr. 13.20; calcium carbon- 
ate, 6.04; sodium chloride, 11.54; sodium sulphate, 128.97; mag- 
nesium sulphate, 137.98; carbonic acid gas free and semi-combined, 
8.06 cubic inches. An agreeable and certain purgative, employed 
in constipation, acidity, etc. 

Leamington {Warwickshire, England). Ingredients: calcium 
and sodium chlorides, and sodium sulphate. Prescribed in acidity, 
dyspepsia and constipation. 



352 MATERIA MEDIC A AND THERAPELTICS. 

MILD ACRID CATHARTICS. 

RHEUM— RHUBAR B. 

Rhubarb is the root of Rheum officinale, and of other species 
of Rheum (Nat. Ord. Polygonaceae). Several varieties of rheum 
are cultivated in Europe and this country, the leaf-stalks of which 
make excellent tarts. 

Rhubarb is prepared for the market by being cleansed, deprived 
of its cortical portion, cut into pieces, pierced through the centre, 
strung upon a cord, and dried in the sun. Three principal sorts 
were long known : Chinese, Russian or Turkey, and European. 
The first two were obtained, by different routes, from central Asia. 
I. Chinese Rhubarb is the common variety, and is imported prin- 
cipally from Canton It occurs in roundish pieces, sometimes 
flattened, of a dirty brownish-yellow color externally (the cortical 
portion apparently scraped off), having a ragged fracture (which 
presents red, yellowish and white veins), and is often perforated 
with holes, with portions of the cord on which it was dried occasion- 
ally remaining. It has a peculiar odor, an astringent, somewhat 
bitter taste, is gritty when chewed, and tinges the saliva of a yellow 
color ; its powder is yellowish, with a reddish-brown tinge. 2. 
Russian Rhubarb had within a few years past disappeared as an 
article of commerce, and will not therefore be described. 3. Euro- 
pean Rhubarb is of uncertain quality, and is seldom found in the 
shops. The kind most frequently met with is English rhubarb, 
which is thought to be derived from R. rhaponticum, and generally 
comes in pieces five or six inches long and about an inch thick, 
and is called stick-rhubarb. It is lighter, more spongy and redder 
than the Asiatic varieties, with a feebler odor and less bitter taste, 
and when broken exhibits a more compact and regular marbling. 
Lately the production of English rhubarb has much increased, and 
its quality has improved. 

Chemical Constituents. — Rhubarb imparts its virtues to both 
water and alcohol, but they are impaired by long boiling. Its most 
important chemical consitituents seem to be chrysophan, chryso- 
phanic acid (C 15 H 10 O 4 ) (an orange-yellow crystalline substance, 
which is probably the active ingredient of goa powder, and will be 
considered in the article chrysarobin-— vide Rubefacients), four 
resins, erythrorctin, emodin, phceoretin, aporetin, and two acids, rheo- 



Fig. 34- 




RHUBARB-ROOT. 



FIG. 35. 




RHUBARB ; (transverse section of root ) 



2 3 



354 MATERIA MEDICA AND THERAPEUTICS. 

tannic (C 26 H 26 14 ), and rheumic (C 20 H 16 O 9 ), but the precise chemical 
constituents of rhubarb are still uncertain, though they have been 
subjected to numerous analyses. It is supposed the therapeutical 
properties of the drug depend chiefly on the conjoint operation of 
these principles. 

Effects and Uses. — In small doses, rhubarb is an astringent 
tonic. In larger doses, it is a slow and mild cathartic, occasionally 
causing griping and accelerating the pulse, but never inflaming the 
mucous membrane of the alimentary canal like the drastics. It 
tinges the milk and urine yellow. It increases the secretion of bile, 
which, however, is unaltered in composition (Rutherford). 

Medicinal Uses. — It is much employed as a purgative in diar- 
rhcea, in which it is particularly useful from its secondary astringent 
effects, and in dyspepsia attended with costiveness, where it acts 
both as a stomachic and laxative. It is not adapted to febrile or 
inflammatory cases. In the bowel complaints of children, rhubarb 
deservedly enjoys great popularity. Made into a cataplasm and 
applied to the abdomen, it acts as a purgative on children. 

Administration. — Dose, as a stomachic laxative, gr. v-x ; as a 
purgative ', gr. xx-5j. The following are the official preparations : 
Extract (alcoholic), dose, gr. x-xxx ; fluid extract, dose f5ss ; mix- 
ture of rhubarb and soda contains sodium bicarbonate, fluid extract 
of rhubarb and spirit of peppermint, each 30 parts, water enough to 
make 1000 parts — an excellent preparation where rhubarb is indi- 
cated, combined with an antacid, especially adapted to children — 
dose, for a child, f5ss-j, for an adult, foj-iv, or more; tincture (100 
parts contain 12 parts of rhubarb and 2 parts of cardamom, in 
diluted alcohol) ; aromatic tincture of rhubarb contains also cinna- 
mon, cloves, and nutmeg, and is used in making the aromatic syrup; 
sweet tincture of rhubarb contains also glycyrrhiza, anise, and carda- 
mom ; tincture of rhubarb and senna (Warner's gout cordial), tincture 
of rhubarb and aloes and tincture of rhubarb and gentian are no 
longer official: the dose of all the tinctures is foss-j, and they are 
chiefly adapted to low forms of disease and persons accustomed to 
the use of stimulants ; pills of rhubarb, each pill contains rhubarb 
gr. iij, and soap gr. j ; compound pills of rhubarb, each pill contains 
rhubarb gr. ij, aloes gr. iss, myrrh gr. j, oil of peppermint gr. T V ; 
compound powder of rhubarb (containing 25 parts of rhubarb, 65 
parts of magnesia, and 10 parts of ginger) ; syrup contains also 
cinnamon, potassium carbonate, sugar, and water; aromatic syrup 



CA THAR TICS— A L OES. 355 

(contains aromatic tincture, 10 parts, syrup, 90 parts — much used 
in infantile cases under the name of spiced syrup of rhubarb) — dose, 
for an infant, f5j ; and wine contains rhubarb, 10 per cent., and 
calamus, 1 per cent., in stronger white wine — dose, f5j-fSss. 
Roasting impairs the cathartic power of rhubarb, and is said to 
increase its astringency. 

Juglans. The inner bark of the root of Juglans cinerea, or 
Butternut {Nat. Ord. Juglandacese), an indigenous forest tree found 
throughout New England, the Middle and Western States and 
Canada, possesses cathartic properties resembling those of rhubarb. 
It is of a fibrous texture, a white color, gradually changing to a 
dark-brown, a feeble odor, and a bitter, somewhat acrid taste. It 
contains nucin, C 36 H 12 O 10 (composed of juglandic acid and juglone), 
some tannic acid, fixed and volatile oils, resin, etc. It is not given 
in substance ; the extract is official, of which the dose is gr. v-x as 
a laxative, and gr. x-xxx as a decided cathartic. 

ALOE -ALOES. 

Aloes is the inspissated juice of the leaves of Aloe socotrina 
{Nat. Ord. Liliaceae), a succulent herbaceous plant growing in 
warm countries. Aloes obtained from other varieties of aloe is used, 
but the Pharmacopoeia only recognizes Aloe socotrina as the source 
of official aloes. The finest kinds are obtained by exudation ; 
those prepared by expression and by boiling are inferior. Three 
principal varieties are known in commerce : Cape, Socotrine, and 
Barbadoes aloes, the first two of which are the most used in the 
United States. 1. Cape aloes {Aloe capensis), which is much the 
most common, is obtained from the Cape of Good Hope, where it 
is collected indiscriminately from A. spicata and other species. Its 
powder is greenish-yellow ; its odor is strong and disagreeable, but 
not nauseous. 2. Socotrine aloes (Aloe socotrina), when genuine, is 
the choicest variety. It is produced in the island of Socotra, on the 
northeastern coast of Africa, from A. socotrina, and occurs in pieces 
of a yellowish or reddish-brown color, becoming darker on exposure 
to the air, with a smooth and conchoidal fracture, the interior being 
lighter-colored than the exterior. Its powder is golden-yellow ; its 
odor peculiar, but not unpleasant, and its taste bitter and disagree- 
able, but aromatic. Hepatic aloes is probably an inferior variety of 
Socotrine, and is seldom met with in our shops. 3. Barbadoes 



356 MATERIA MEDICA AND THERAPEUTICS 

aloes (Aloe barbadcnsis) comes from the West Indies, the product 
chiefly of A. vulgaris ; it is imported in gourds. The taste of all 
the varieties of aloes is intensely bitter and very tenacious ; their 
odor, disagreeable. 

Chemical Constituents. — Aloes yields its virtues to water 
and alcohol. A neutral crystalline principle, termed alo'in, has been 
extracted from it, which is supposed to be the cathartic principle, 
and which has been used as a purgative in doses of gr. T V-ij ; that 
from Socotrine aloes is termed socaldin (C 15 H 16 7 ), of Barbadoes, 
barbaldin (C ir H 20 O 7 ), and of Natal, nataldin (C 16 H 18 7 ). The resin of 
aloes, when exhausted of alo'in, possesses no purgative properties. 

Effects and Uses. — Aloes, in small doses, is tonic, and in 
large doses, purgative. As a cathartic, it is remarkable for the 
slowness of its operation and its special action on the large intestine 
and the pelvic viscera generally. Hence it is objectionable in cases 
of disease of the genito-urinary apparatus, pregnancy, etc. ; and, on 
the other hand, is useful in amenorrhcea. It also stimulates the 
hepatic secretion. 

It is principally employed in cases of dyspepsia accompanied by 
costiveness, dependent on a torpid condition of the large intestine 
or liver. In chronic constipation, combined with belladonna and 
nux vomica and continued for some time in small doses, it often 
proves advantageous. 3^ Aloin, gr. T V; extracti nucis vomicae, gr. 
yi ; extracti belladonnas, gr. T \. M. ft. pil. I. Sig. — One pill t. d. 
after meals, to be reduced to two per diem if it cause more than one 
daily evacuation. Active exercise, massage and regular habits add 
greatly to the efficiency of this treatment. It is also useful as a 
mild revulsive in cerebral affections, and has proved efficacious as 
an anthelmintic against thread-worms. It was once thought that it 
was objectionable in hemorrhoids, but this affection being now con- 
sidered to depend upon relaxation of the veins of the rectum, aloes 
has been administered in it upon theoretical views, and with very 
good results. As a purgative it holds an intermediate rank between 
rhubarb and senna. 

Administration. — Dose, gr. v or x-xx, in pill; it is usually 
given in combination with other cathartics. Aloes is so often mixed 
with impurities that, for medicinal use, it is best employed under 
the form of aloe purificata (purified aloes), which is prepared by 
straining and evaporating an alcoholic solution of Socotrine aloes. 
The official preparations are : Pills of aloes, consisting of equal parts 



CA THA R TICS—SENNA. 357 

of aloes and soap, one pill containing aloes gr. ij; pills of aloes and 
mastic, 4 parts of aloes to 1 part of mastic and red rose, each (the 
Lady Webster pill, each containing aloes gr. ij); pills of aloes and 
asafcetida (one pill contains of aloes, asafcetida, and soap, jj^ gr. 
each), useful in flatulent constipation ; pills of aloes and myrrh, or 
Rufus's pills, aloes, 4 parts, myrrh 2 parts, and aromatic powder 1 
part, made into pills with syrup; employed in amenorrhcea, each 
pill containing aloes gr. ij ; pills of aloes and iron, equal parts of 
aloes, dried iron sulphate and aromatic powder, made into pills with 
confection of rose : each pill contains aloes gr. j ; very useful in 
amenorrhcea ; aqueous extract of aloes (extraction aloes aquosum), 
dose, gr. j-v; tincture (aloes and extract of glycyrrhiza, of each 10 
per cent,, in diluted alcohol), dose, foj to foss; tincture of aloes and 
myrrh (aloes and myrrh, each 10 per cent, in alcohol); wine of aloes 
(aloes 6 per cent, cardamom and ginger each I per cent., in stronger 
white wine). 

SENNA. 

Senna consists of leaflets of several species of Cassia (Nat. 
Ord. Leguminosae), small shrubs which grow in the tropical regions 
of Asia and Africa. The species recognized as official are C. 
acutifolia and C. elongata ; and beside these, C. obovata, C. lance- 
olata, and C. aethiopica are also generally received as sources of the 
drug. The commercial varieties of senna which are found in the 
United States are the Tripoli, the India and the Mecca senna. 1. 
Alexandria senna, which comes from-the port of this name in Egypt, 

Fig. 36. Fig. 37. 





ALEXANDRIAN SENNA. INDIAN SENNA. 

is made up chiefly of the leaflets of C. acutifolia (which are yellowish- 
green, acute in shape, and less than an inch in length), intermingled 
with the pods, leafstalks, flowers, etc., of this plant. 2. Tripoli 
senna consists of the leaflets of C. aethiopica, which are shorter, less 
acute, thinner and more fragile than those of C. acutifolia, and are 
generally much broken up. 3. India senna is produced in Arabia 
and consists of the leaflets, intermixed with the leafstalks and pods, 
of C elongata, and is readily recognized by the long, narrow, pike- 
like shape and dark hue of the leaflets. A finer variety of India 



358 MATERIA MEDICA AND THERAPEUTICS. 

senna, cultivated at Tinnevelly, in Hindostan, has been known for 
some years past, which is distinguishable from the common sort of 
India senna, by the bright-green color of the leaflets. 4. Mecca 
senna consists of leaflets, intermediate in length between those of 
C. elongata, and has in mass a yellowish, tawny hue. It is proba- 
bly the product of C. lanceolata. Cassia obovata has been lately 
found growing in wild abundance in Jamaica. 

Preparation and Chemical Constituents. — Commercial is 
prepared for use by separating the leaflets from the stalks, adulter- 
ations, etc. ; the pods possess cathartic properties, but are less active 
than the leaves. The odor of senna is faint and sickly; its taste 
bitter, sweetish and nauseous. It imparts its virtues to water and 
alcohol, its infusion being of a reddish-brown color. The chemical 
composition of senna has long been an unsettled point. By the 
latest analysis it has been found to contain a glucoside, cathartic 
acid, which is insoluble in water, stronger alcohol and ether, but 
which enters readily into watery solution with alkaline and earthy 
bases in which state it exists in senna; this is actively cathartic. 
Catharto-mannit [sennit), sennacrol and chrysophan have been also 
obtained; and there is probably another purgative principle which 
has not been isolated. 

Effects and Uses. — Senna is a prompt, efficient and safe ca- 
thartic, well adapted to febrile and inflammatory cases ; it operates 
on the entire tract of the intestinal canal, and produces watery, fecu- 
lent discharges. Prof. Rutherford found that senna was a mild 
hepatic stimulant, and rendered the bile more watery. Its tendency 
to gripe may in a great measure be counteracted by combining aro- 
matics or neutral salts with it; the addition of bitters promotes its 
cathartic activity. 

Administration. — The dose in powder is 5ss-ij ; Confectio 
sennce (made with senna, coriander, sugar, figs and pulp of prunes, 
tamarinds and purging cassia) is an excellent mild cathartic, much 
used for pregnant women; dose, 5ij- Of the fluid extract the dose 
is f5j-iv; the compound infusion (black draught) contains senna, 
manna, magnesium sulphate and fennel ; dose, f§ss-j or more. 
Syrup of senna contains senna, sugar, alcohol and oil of coriander; 
dose, f 5j • Pulvis glycyrrhizce compositus (compound powder of ' glycyr- 
rhizd) consists of senna, glycyrrhiza, fennel, washed sulphur and 
sugar. It is an excellent purgative; dose, a teaspoonful of the pow- 
der in half a glass of water at bedtime. An extract of the pods 
may be used ; it is less likely to grip:. 



CA THA R TICS—FRA NG ULA . 359 

LEPTANDRA. 

The rhizome and rootlets of Leptandra virginica, Culver's 
Root, or Culver's Physic {Nat. Ord. Scrophulariaceae), an herb- 
aceous perennial plant, three or four feet high, with leaves in whorls, 
and a long spike of white flowers, are ranked as a cholagogue ca- 
thartic. It consists of a dark-brown rhizome, from two to four lines 
in thickness, several inches in length, with numerous long, slender 
radicals. The odor is feeble and disagreeable, the taste bitterish 
and somewhat nauseous and acrid. Water and alcohol extract its 
virtues, which depend on leptandrin. It also contains resin, saponin, 
tannin, mannit, etc. 

Effects and Uses. — It is only a feeble stimulant to the liver 
and intestinal glands, according to the investigations of Rutherford. 
Adolphus * states that it acts on the small intestines, pancreas, and 
liver, while Dutcher f thinks it stimulates the intestinal glands only, 
but they offer no evidence to prove their statements. Dose of the 
powdered root, gr. xx to 5j ; of an impure resin mis-named leptandrin 
(made by precipitating a tincture of the root with water), gr. ij-iv; 
an extract (dose, gr. ij-iv) and fluid extract (dose, f5ss-j) also have 
been used. 

FRANGULA. 

The bark of Rhamnus Frangula, J or Alder Buckthorn (Nat. 
Ord. Rhamnaceae) is a mild purgative of some value. Frangula is 
a shrub growing to the height of ten feet or more, found in wet 
places along the northern coast of Africa, throughout Europe, and 
in Siberia. It has alternate oval leaves, slightly pointed at the 
apex, greenish flowers in axillary clusters and small red berries, 
which finally become black and contain two or three roundish-an- 
gular seeds. The bark comes in small quills, grayish or blackish- 
brown externally, and marked with numerous small, whitish, trans- 
versely elongated warts; the inner surface is smooth, pale, brownish- 
yellow. It has no smell and a sweet and bitterish taste. It con- 
tains frangidin (C 20 H 20 O 10 ), emodin, resin, tannin, etc. 

Effects and Uses. — When fresh the bark is an active emetic 
and hydragogne cathartic, possessing irritant qualities, but it loses 
much of its acridity in drying, and it is therefore recommended by 



* Boston Med. and Surg. Reporter, 1868, p. 23. f Ibid., 1868, p. 275. 

% Med. Times, Dec. 5th, 1887, on " R. Frangula and Purshiana," Rusby. 



360 MATERIA MEDIC A AND THERAPEUTICS. 

the Pharmacopoeia to be collected at least a year before it is used. 
When dried it is a mild acrid cathartic, proving also somewhat 
diuretic. It is also an anthelmintic of considerable value against 
thread-worms. The fluid extract may be given in doses of f5ss-j. 

CASCARA SAGRADA. 

Cascara sagrada* or Chittem bark (not official) is the bark of 
Rhamnus purshiana (Nat. Ord. Rhamnaceae), a small tree found on 
the Pacific slope, growing to the height of ten to twenty feet, with 
elliptic denticulate leaves, rather large white flowers in umbellate 
clusters, and three-lobed, three-seeded black drupes. The bark 
comes in thin quills, with a grayish periderm, underneath. which it is 
of a reddish-brown color; the inner surface is smooth and yellowish. 
It is without smell, but has a bitter taste. 

Chemical Constituents. — It contains three resins, viz., a 
brown, red, and yellow, which are probably the purgative principles, 
and recently a ferment, glucose, and traces of ammonia have been 
isolated. f 

Effects and Uses. — Cascara bark' is a good and efficient ca- 
thartic and is useful in habitual constipation. As a cathartic, Dujar- 
din-Beaumetz J rates it between podophyllum and rhubarb. Dose 
of the fluid extract, Htx-xxx, beginning with the smallest dose 
three times a day and gradually increasing until a free morning 
evacuation is produced after which the quantity should be carefully 
decreased, giving just sufficient to bring about the necessary morn- 
ing evacuation. According to Cullimore,§ cascara is well combined 
with capsicum in obstinate constipation, which combination obviates 
the griping and aids the action of the former. As great difference 
in action is found in many preparations of the drug, it is well to 
begin with a smaller dose on procuring a new supply. 

DRASTIC CATHARTICS. 
JALAPA— JALAP. 

Jalap is the tuber of Exogonium Purga (Nat. Ord. Convolvu- 
laceae), a climbing plant of Mexico, which derives its name from 



* Med. Times, Dec. 5th, 1887, on " R. Frangula and Purshiana," Rusby. 
f Am. Tourn. of Pharm., Feb., 1888. "An Exam, of Cascara Sagrada," by Meier and 
Webber. 

\ " Les Nouvelles Medications," 1888, p 60. 
$ Lancet, London-, March, 1885, p. 502. 



( : 1 THAR TICS— JALAP. 



361 



the city of Jalapa, near Vera Cruz. The tubers are imported usually 
entire but sometimes in slices. When entire, they vary in size and 
shape from a walnut to a large pear, are hard and heavy — externally, 
brown and wrinkled, and internally, grayish, with brown concentric 
rings ; they are often furrowed with vertical incisions, made to pro- 
mote drying. They have a heavy, rather nauseous smell, and a 
sweetish, subacrid, disagreeable taste. They yield their virtues 
partly to water, partly to alcohol, and completely to diluted alcohol. 



FIG. 38. 




TALAP-TJBERS. 



In the shops jalap is kept in the state of powder, which is of a yel- 
lowish gray color. 

Chemical Constituents. — Its active principle is a resin, which 
consists of two portions, both of which are cathartic; one is soft and 
soluble in ether, the remainder is the glucoside convolvulin (C 62 H 100 
32 ), insoluble in ether; it contains also gum and starch, which is 
apt to be attacked by worms, the worm-eaten pieces becoming thus 
the most active. Both the resins dissolve in oil of turpentine. 



362 MATERIA MEDIC A AND THERAPEUTICS. 

Toxicology. — In overdoses, it may produce dangerous hy- 
percatharsis. Orfila* ascertained experimentally that 5'j by the 
mouth is the fatal amount for a dog. We have met with no fatal 
cases in man. 

Effects and Uses. — Jalap is a powerful hydragogue cathartic 
operating with great promptness, and often causing much pain, its 
carthartic action seeming to be local. Rutherford found that jalap 
was an energetic hepatic stimulant, augmenting the flow of bile, 
which at the same time was made more watery. It also increases 
the secretion of the intestinal glands to a marked degree. Itis em- 
ployed as a hydragogue in dropsy of cardiac or renal origin, when it 
is often combined with cream of tartar; as a revulsive in cerebral 
and other affections, and to increase the action of calomel in bilious- 
ness. It is also a valuable hydragogue in ascites, chronic Bright s 
disease, cerebral hyperemia, uremia, and is sometimes employed as 
an abortifacient. 

Adx\iinistration. — Dose, gr. xv-xxx ; in combination, gr. x. 
Of the abstract, gr. j-v. The compoiind powder of jalap (pulvis 
jalapce compositus) contains 35 parts of jalap and 65 parts of cream 
of tartar; dose, gr. x-5j. The resin is extracted by solution in 
alcohol, and afterward precipitated from the tincture by water ; 
dose, gr. iv-viij. 

BRYONIA -BRYONY. 

Bryonia is the root of Bryonia alba and B. dioica {Nat. Ord. Cu- 
curbitaceae), climbing perennial vines, growing in the thickets and 
hedges in various parts of Europe, with rough, five-lobed, toothed, 
alternate leaves and cymes of three or four small greenish flowers, 
and black or red berries containing six large spotted seeds. The 
root is found in the shops in transverse sections about two inches in 
diameter, with a grayish-brown, rough, thin bark, the central portion 
being whitish, with small woody bundles arranged in circles, and 
projecting, radiating lines. It is without smell, but has a bitter taste. 
The active principle is probably bryonin (C 48 H 80 O 19 ), a bitter glucoside. 

Physiological Effects. — Bryonia is a powerful hydragogue 
cathartic, resembling jalap in its action, but much more violent. It 
also acts on the kidneys, increasing their secretion. 

Toxicology. — In large doses it has produced fatal gastro- 
intestinal inflammation. Christisont records a fatal case following 

* Toxicologic Generate," t. i, p. 68j. f " A Treatise on Poisons," 4th edition, p. 594. 



CA THAR TICS— POD OPHYLL UM. 363 

the swallowing of two glasses of an infusion (strength not stated), 
which was characterized by violent tormina and purging. If 
symptoms of its irritant action appear, the drug should be discon- 
tinued, and opiates, demulcents and stimulants administered. 

Medicinal Uses. — In dropsies it may be used as a drastic cathar- 
tic, with a view of also acting on the kidneys. Phillips recommends 
it in the stage of effusion in plearitis and pericarditis, and where the 
joints are stiff and painful from rheumatic affections. 

Administration. — The tincture is the only official preparation ; 
dose, f5ss-j or more. 

PODOPHYLLUM. 

Podophyllum peltatum, May-apple or Mandrake {Nat. Ord. 
Berberidaceae), is a very common indigenous herbaceous plant, with 
a long, creeping, perennial root, and an upright stem about a foot 
high, separating at the top into two petioles, each supporting a large 
peltate leaf, divided into five or six lobes. At the fork of the peti- 
oles it bears a single flower, which appears in May, the fruit ripening 
in September. The rhizome and rootlets are the parts used. The 
rhizome is found in the shops in wrinkled, jointed, cylindrical pieces, 
about two lines in diameter, of a brown color externally, and yellow- 
ish within, having a tuft of about ten nearly simple fragile rootlets 
on its under surface. The powder is yellowish-gray, and has a 
sweetish smell ; its taste is at first sweetish, afterward bitter, acrid 
and nauseous. 

Chemical Constituents. — Diluted alcohol is the best solvent 
of podophyllum, which has been found to contain two resinous 
cathartic principles ; one neutral, the other acid in reaction (podo- 
phyllinic acid). According to V. Podwissotzki, of Dorpat, podo- 
phyllum and podophyllin both contain a resinous, bitter, amorphous 
substance, which is very active and which he calls podophyllotoxin. 
This consists of two principles, picropodophyllin (crystalline, bitter) 
and podophyllinic acid (inert). Power* has shown that the rhizome 
contains neither berberine nor other alkaloid, and his investigations 
have been confirmed by Maisch. 

Toxicology. — Dr. Dudleyf reports the fatal poisoning of a 
woman who swallowed gr. v of resina podophylli in mistake for 



* Proceedings Am. Pharm. Assoc, 1877, p. 420. ''On the Resin of Podophyllum 
Peltatum." 

f N. Y. Med. Record, April 12, 1890, p. 409. 



364 



MATERIA MEDICA AND THERAPEUTICS. 



mandrake. She was seized with biliary purging and vomiting, 
which was followed by a comatose condition, weak pulse, sighing 
respiration, ending in death in 2^ days. 

Effects and Uses. — Podophyllum is an active hydragogae ca- 
thartic, with an especial determination to the upper portion of the 
alimentary canal, and a pretty decided cholagogue action which, 



FIG. 39. 




PODOPHYLLUM PELTATUM. 



according to Rutherford, is due to stimulation of the hepatic secret- 
ing apparatus, and is greater when purgation is not profuse, and 
vice versa. He also concludes that the purgation is due to intestinal 
irritation, which is essentially the conclusion reached by Anstie.* 
Podwissotzki found that the effects of podophyllum depended upon 



* Med. Times and Gazette, Vol. i, 
Podophyllin." 



pp. 326, 487; ''Report on the Phys. Action of 



CA THAR T/CS— CHELID ONIOM. 365 

picropodophyllitiy small doses of which caused purging, while large 
doses produced vomiting. As this is very expensive when pure, he 
recommends a I per cent, solution of podopJiyllotoxin in alcohol, 
which he gives in doses of gtt. xxx in wine. As a clwlagogue and 
purgative, one of the following pills may be given at bedtime : 1^ 
Resinae podophylli, gr. ij ; extracti colocynthidis compositi, gr. xxiv; 
extracti belladonnae, gr. iij. M. Ft. pil. xij. The hydragogue effects 
of podophyllum make it useful in ascites and dropsy. It is an ingre- 
dient in several cathartic nostrums. 

Administration. — Dose, in powder, gr. xx; of the abstract, 
gr. %-] ', of the fluid extract, TTlx-xx; of the extract (alcoholic), 
gr. v-xv; of the resin , gr. %-)• 

CHELIDONIUM. 

Chelidonium majus, known also as Celandine or Tetterwort 
{Nat. Ord. Papaveraceae), is a perennial herb growing in waste 
places, indigenous to Europe, but naturalized in North America. 
The stem is about two feet high, and hairy ; the leaves are alternate, 
the upper ones sessile, light-green above and glaucous beneath, ly- 
rately pinnatifid, the pinnae ovate-oblong, obtuse, coarsely crenate 
or incised. The flowers appear from May to September, are of a 
bright golden-yellow color, and arranged in small axillary umbels 
on long peduncles. 

Chemical Constituents. — Chelidonium contains two alka- 
loids, chelerythrine (C 19 H 17 N0 4 , not identical* with sanguinarine) 
and chelidonine (QgH^NgOg), combined with chelidoninic acid, 
which is identicalf with succinic acid. 

Effects and Uses. — The physiological action of this drug 
has not been investigated. It has been used as an hydragogue ca- 
thartic, and is said to possess narcotic properties. Binz and Phillips 
both believe that it exerts a stimulating effect upon the hepatic 
secretions, and class it with podophyllum and iris. Dose of the 
powder, gr. x-5j ; or it may be given in extract or infusion. There 
are no official preparations. 



* Pharm. Zeitung, Berlin, 1886, p. 577 ; also Journ. de Med. de Ckir. et de Pharm., 
Bruxelles, 1868, p. 268. 

f Ber. der deutsch chem. Ges., 1886, XV, p 704. 



366 



MATERIA MEDICA AND THERAPEUTICS. 



IRIS. 



The rhizome and rootlets of Iris versicolor, or Blue-flag 
(Nat. Ord. Iridaceae), are used as a powerful hepatic stimulant. 



Fig. 40. 




iris versicolor; rhizome and rootlets. 
Fig 41. 




IRIS VERSICOLOR. 



The Blue-flag is found in the swampy meadows of North America, 
having sword-shaped leaves and a stout stem, bearing a few blue 



LA THARTICS—SCAMMONY. 367 

flowers, appearing late in the spring. The rhizome is horizontal 
and jointed; is long and cylindrical in its lower half, broad near its 
upper extremity, and terminated by a circular scar, annulated from 
the leaf-sheaths, of a grayish-brown color, with long rootlets crowded 
near the broad end. It has a slight odor and a nauseous, acrid 
taste (Maisch). It contains a resin, to which probably its medicinal 
qualities are due. 

Effects and. Uses. — In large doses the fresh plant causes vio- 
lent vomiting and purging, with much depression: in smaller 
doses it is a cliolagoguc and diuretic. The qualities are impaired 
by drying. Rutherford found that iridin (an impure oleo-resin) 
was a powerful hepatic stimulant, producing less intestinal irritation 
than podophyllin, but greater purgation than euonymin. It was 
also a decided stimulant to the intestinal glands. It is highly 
recommended in jaundice of malarial origin, and may be given 
with advantage in torpidity of the liver and dropsy. The fluid extract 
{extr actum iridis fliddum) may be given in doses of TTLxx-f3j. 
An extract also official. 

EUONYMUS. 

Euonymus or Wahoo is the bark of Euonymus atropurpureus 
{Nat. Ord. Celastracese), a handsome shrub of northern and middle 
portions of the United States, found in shady woods. " Its branches 
are slightly quadrangular ; the leaves opposite, petioled, elliptic- 
ovate, serrate, and pointed ; the flowers dark-purple, in loose cymes 
of three to six, and appear in June." The fruit matures in autumn, 
and consists of pendulous capsules of a bright crimson color. The 
bark, as seen in the shops, is of a grayish color, mottled with blackish 
patches on its outer surface, which is detached in thin and small 
scales ; inner surface tawny and smooth. It is without smell, and 
has at first a sweetish taste, which afterward becomes bitter and 
acrid. It contains a bitter-principle, enonymin, resins, euonic acid, etc. 

Effects and Uses. — Euonymus is an excellent cathartic, in- 
creasing the intestinal secretions to some extent, and acting as a 
powerful hepatic stimulant. It may be advantageously used in 
cases of torpor of the liver and constipation. The extract is the only 
official preparation ; dose, gr. iij-v. 

SCAMMONIUM-SCAMMONY. 

Scammony is a resinous exudation from the root of Convolvu- 
lus Scammonia {Nat. Ord. Convolvulacese), a twining plant of Syria. 



368 MATERIA MEDICA AND THERAPEUTICS. 

Preparation, Description and Constituents. — The finest 
kind is the product of exudation from the sliced root; but most 
of the drug which reaches us is probably obtained by expression, 
or by evaporation of a decoction of the root. It comes from the 
Levant. Genuine scammony, termed Virgin Scammony, occurs in 
light, irregular, friable pieces, of various shades of color, from dark- 
ash to dark-olive, covered with a whitish-gray powder, and break- 
ing with a bright-greenish fracture; they should not effervesce with 
an acid. The scammony of the shops, which is always more or 
less adulterated, is in hard, heavy, saucer-shaped cakes, from four 
to six inches in diameter (sometimes broken into pieces), of a dark- 
ash or slate color. The powder is light-gray ; the smell disagree- 
able, like ttiat of old cheese, the taste at first feeble, afterward 
bitterish and acrid. Scammony is a gum-resin, the resin constitut- 
ing from 80 to 90 per cent, of the weight of good scammony, and 
called scammonin (C 34 H 5( j0 16 ). It is a colorless and tasteless sub- 
stance, having a peculiar faint, sweetish smell, and being soluble 
in alcohol and ether. 

A factitious scammony made in France, and known as Mont- 
pellier Scammony, is occasionally imported into the United States. 
It is blacker than the genuine article, has a feeble balsamic odor and 
a very bitter, nauseous taste. 

Toxicology. — There are no recorded fatal cases of poisoning 
by scammony. Orfila* ascertained that so much as 5iv in dogs 
only produced diarrhcea. 

Effects and Uses. — Scammony is an energetic hydragogue 
cathartic, operating sometimes with great violence, and seldom given 
except in connection with other cathartics. When active catharsis 
is indicated it may be employed in ascites, chronic Brighfs disease, 
cerebral hyperemia, and guardedly as an abortifacient. 

Administration. — Dose, gr. v-xv of the pure drug, gr. x-xxx 
of the drug of the shops ; of the resin, gr. iv-viij. Scammony-resin 
is of pleasanter smell and taste than jalap-resin, produces less grip- 
ing, and is less apt to cause vomiting. It is much used in the form 
of compound extract of colocynth. 

COLOC YNTHIS— COLOCYN TH. 

Colocynth is the fruit (deprived of its rind) of Citrullus Colo- 
cynthis or Bitter Cucumber (Nat. Ord. Cucurbitaceae), an annual 

* '* Toxicologic Generale," Vol. I, p. 758. 



CA THARTICS- COLOCYNTH, 3G9 

plant of the south of Europe and parts of Asia and Africa, resem- 
bling the common watermelon. The fruit has a thin but hard rind, 
but is peeled and dried for exportation, and comes to us from the 
Levant. 

Description and Constituents. — It consists of light, whitish, 
spongy balls, about the size of a small orange, filled with numerous 
seed. For medicinal use the pulp only is employed, and the seed, 
which are inactive are rejected. The pulp has a feeble odor and a 
nauseous, intensely bitter taste. It yields its virtues to both water 
and alcohol, and contains a peculiar glucoside termed colocynthin 
(CggH^O^), resin, colocynthitin, etc. 

Toxicology. — Christison* describes a case in which a tea- 
spoonful and a half of the powder killed a man, while Husemanf 
mentions an instance in which 5/^ proved fatal to a woman, and of 
recovery after swallowing 5iij. 

Fig. 42. 




COLOCYNTH (PEELED). 

Effects and Uses. — Colocynth is an hepatic stimulant, increas- 
ing the amount of the biliary constituents as well as rendering the 
bile more watery and at the same time stimulating the intestinal 
glands (Rutherford). It is a violent hydragogue carthartic, acting 
sometimes very harshly even in small doses, and in overdoses pro- 
ducing dangerous, and occasionally fatal, enteric inflammation. Its 
chief use is to unload the bowels in obstinate constipation. 

Administration. — The dose is gr. v-x. It is seldom, how- 
ever, administered alone. The extract (alcoholic) is used chiefly in 
the preparation of the compound extract, which contains also aloes, 
resin of scammony, cardamom and soap ; this is a favorite prescrip- 
tion, but it is apt to gripe, and it is well to combine some aromatic 
with it, as a little oil of cloves or capsicum ; dose, gr. v-x. 

* "A Treatise on Poisons," 4th ed., p. 595. f " Handbuch der Toxicologic," p. 625. 
24 



370 MATERIA MEDICA AND THERAPEUTICS. 

CAM BOGIA— GAMBOGE. 

Gamboge is a gum-resin procured from Garcinia Hanburii 
(Nat. Ord. Guttiferse), a tree of Siam and Cochin-China. 

Preparation, Description and Constituents. — The juice is 
collected in a bamboo joint as it exudes from a spiral incision in the 
bark, extending nearly round the tree, and is afterward reduced to a 
solid consistence by the aid of heat. The sap exudes slowly for seve- 
ral months, and the tree is not injured by the process. It is imported 
from Canton and Calcutta, and occurs in cylindrical rolls from one 
to three inches in diameter, of an orange color, known as pipe gam- 
boge, or in irregular masses (which are less pure), weighing two to 
three pounds or more, called cake or lump gamboge. Good gamboge 
is opaque, brittle, inodorous, nearly insipid, and breaks with a vitre- 
ous fracture; its powder is bright-yellow. It is a gum-resin, form- 
ing a yellow, opaque solution with water and a golden yellow solu- 
tion with alcohol; it contains from 20 to 25 per cent, of gum and 
from 75 to 80 per cent, of a resin termed cambogic acid (QqH^OJ. 

Toxicology. — Christison* mentions a case in which 3j proved 
fatal, the symptoms being excessive vomiting, purging and faint- 
ness. 

Effects and Uses. — Gamboge is a powerful hydragogue, and 
in overdoses has proved fatal. Sometimes it causes vomiting, and 
in large amounts has produced death merely from depression. It 
is employed in obstinate constipation ; in dropsies, combined with 
cream of tartar or jalap ; and has been used to destroy tcenia solium. 

Administration. — Dose, gr. ij.-vj. It is usually prescribed 
with other and milder cathartics, to promote and accelerate their 
action. Compound cathartic pills (pilidce catharticce composite?) are 
made by mixing compound extract of colocynth (gr. 130), extract 
of jalap and calomel (of each, gr. 100), and gamboge (gr. 25), with 
water, forming a pilular mass, to be divided into 100 pills. Three 
of the pills, containing gr. iofc$ of the mass, represent gr 3.9 of 
compound extract of colocynth, gr. 3 of extract of jalap and calo- 
mel each, and gr. ^ of gamboge. 

elaterinum— elaterin. 
Elaterine (C 20 H 28 O 5 ) is a neutral principle extracted from 
elaterium, a substance deposited by the juice of the fruit of Ecbal- 

* "A Treatise on Poisons," 4th ed., p. 603. 



CATHARTICS— CROTON OIL. 371 

Hum Elaterium, or Squirting Cucumber {Nat. Ord. Cucurbitaceae), 
an annual vine of the south of Europe, now cultivated in England. 
The fruit has the shape of a small oval cucumber, and, when fully 
ripe, separates from the peduncle, and throws out its juice and 
seeds with considerable force, through an opening in the base. 

Preparation and Constituent. — Pure elaterium is obtained 
by slicing the fruit and allowing the juice to drain through a sieve. 
The juice deposits a sediment, which dries in very light, thin, nearly 
flat, pulverulent, greenish-gray cakes, and is the genuine elaterium. 
It is almost inodorous, and has a bitter, acrid taste. The com- 
mercial elaterium, which is obtained from England, is made by ex- 
pression. The drug is to be considered inferior when it is dark- 
colored, much curled, and hard. Elaterium yields its virtues to 
alcohol and not to water. Elaterin, its active principle, crystallizes 
in beautiful colorless, needle-shaped crystals, without smell, but of 
a bitter, sharp taste, insoluble in water, but readily soluble in 
alcohol. 

Toxicology. — Beck* mentions a case in which extract of elat- 
erium, gr. ijf, with gr. xvj of rhubarb caused death, the chief symp- 
toms being incessant vomiting and purging. 

Effects and Uses. — Elaterium is an hydragogue cathartic of 
great violence of operation, possessing some diuretic action, and in 
overdoses has frequently proved fatal. It is a very efficient remedy 
in the treatment of dropsies, and is also a useful revulsive in cere- 
bral affections ; but in administering it, considerable caution is re- 
quired. It is occasionally employed as an hydragogue in ascites, 
chronic Bright s disease, cerebral hyperemia, and as an abortifacient. 

Administration. — Trituration of elaterin {trituratio elaterini) 
consists of elaterin 10 parts and sugar of milk 90 parts, thoroughly 
triturated; dose, gr. %-}. It is safest to begin with the smaller 
dose. Elaterin proves powerfully cathartic in doses of gr. aVxV 

OLEUM TIGLII— CROTON-OIL. 

Croton oil is a fixed oil obtained from the seeds of Croton 
Tiglium {Nat. Ord. Euphorbiacese), a small tree of the East Indies. 
The croton-seeds resemble the castor-seeds in shape and size, and 
consist of a blackish shell, sometimes covered with a yellowish- 

* " Med. Jurisprudence," 6th ed., II, p. 578. 



872 MATERIA MEDICA AND THERAPEUTICS. 

brown epidermis, and inclosing a yellowish oily kernel. They are 
highly irritant and cathartic, but are not imported into this country. 
Chemical Constituents. — They contain a volatile oil, a fixed 
oil, retin, acetic, butyric, and valerianic acids, together with an 
acid termed tiglinic (C 5 H 8 2 ). The croton oil of the shops is ob- 
tained by expression, and is a mixture of the fixed oil proper, the 
resin and tiglinic acid. According to Senier* the vesicating prin- 
ciple resides in the non-volatile fatty acids, or in that part of the oil 



Fig. 43. 




CROTON-OIL SEEDS. 

soluble in alcohol. The oil is made in both India and England, the 
Indian oil being of a pale straw color, and the English reddish- 
brown ; the latter is the variety now found in the shops. It has a 
viscid consistence, which is increased by age, a faint, peculiar odor 
and an extremely acrid, pungent taste; it is soluble in ether and the 
volatile and fixed oils, and partially so in alcohol. The drastic 
principle has been found by Senier (loc. cit) to exist in that portion 
of the oil insoluble in alcohol, which he styles the " Alcohol non- 
soluble, non-vesicating oil." This he determined experimentally to 
be purgative in the dose of 1T[ tW, his work being confirmed by Dr. 
Meek (same article as Senier's). Tests. — There are no exact chem- 
ical tests by which croton oil can be recognized in medico-legal 
cases. 

Toxicology and Antidotes. — In overdoses it has frequently 
proved fatal, destroying life rather by its depressing influence on the 
functions of organic life through the nervous system than by a local 
irritant action. When the latter is present it partakes of the cha- 
racter of gastro-enteritis. The fatal quantity varies widely, since 
Tflnj killed a child aged 13 months,! while recovery has followed 



* The Pharm. Journ. and Trans., 1883, p. 446. 
f Med. Times and Gazette, I, 1870. 



MERCURIAL CATHARTICS. 373 

after swallowing foj (a child*), and in adults f5ij,* fSijf (without 
purging) and fSj.J In cases of poisoning demulcents, as linseed- 
tea, must be given, and the stomach emptied. 

Physiological Effects. — Rubbed on the skin, croton-oil causes 
rubefaction and a pustular or vesicular eruption; and rubbed over 
the abdomen it will sometimes purge. The eruption ordinarily 
appears in a few hours and lasts about four days. Croton-oil, taken 
internally, is a powerful hydragogue purgative, occasionally increas- 
ing also the secretion from the kidneys. Gtt. j-ij are usually suffi- 
cient to produce active catharsis, but sometimes as much as gtt. 
viij-x may be taken without affecting the bowels. It operates very 
speedily, often causing evacuations in half an hour, and is apt to 
produce considerable sedation of the vascular system. 

Medicinal Uses. — Croton oil, from the smallness of the dose 
required and the speediness of its action, is an extremely valuable 
purgative in obstinate constipation, as an hydragogue in ascites, and 
in cerebral disorders, particularly hyperemia and apoplexy. Its ex- 
hibition in the latter disease is indicated when the arterial tension is 
high and there is evidence of cephalic congestion, as manifested by 
an incompressible pulse and facial flushing. Cardiac failure is a 
contraindication to the use of croton oil in apoplexy. As a counter- 
irritant, it is often employed with advantage in pulmonary and 
laryngeal affections, diseases of the joints, etc. In chronic laryngitis, 
and bronchitis, it may be applied externally diluted with olive-oil 
upon a camel's hair brush about the throat or over the sternum. 

Administration. — Dose, gtt j-ij, made into pill with bread- 
crumb. For external use, it may be diluted with one or two parts 
of olive-oil or oil of turpentine. 

mercurial cathartics. 

The preparations of mercury employed as cathartics are calomel 
and blue pill. Their purgative effects depend partly on the increased 
flow of bile which they occasion, and partly on the stimulus which 
they give to secretion from the mucous follicles of the intestinal 
canal and from the pancreas. They probably do not increase the 
amount of bile secreted, but by irritation of the orifice of the duct, 



*'* Handbuch der Toxicologic," Huseman, p. 443. 

f Am. J. Med. Set., April, 1874, p. 416. 

J Bostofi Med. and Surg. Journ., 1868, p. 294. 



374 MATERIA MEDIC A AND THERAPEUTICS. 

cause reflex contraction of the ducts and the gall-bladder, and con- 
sequently expulsion of that already secreted. They are rarely em- 
ployed alone, owing to the slowness and uncertainty of their action, 
but are usually combined with or followed by other cathartics (as 
jalap, senna, rhubarb, compound extract of colocynth, or some of 
the saline preparations). The mercurial cathartics are usually ad- 
ministered with a view of combining a purgative action with an effect 
on the secretions, particularly that of the liver; also as anthelmintics 
and as revulsives in cerebral and other affections. They are well 
adapted to infantile cases, from the facility of their administration, 
and are especially beneficial in the ephemeral febrile attacks to 
which children are subject; they, moreover, rarely produce salivation 
in children. 

Hydrargyri Chloridum Mite {Mild Chloride of Mercury, or Cal- 
omel). (Noticed at length under the head of Alteratives^) Dose, as 
a cathartic, gr. j-xij, in pill, powder, or it may be taken with syrup 
or molasses ; to be followed, in from four to six hours, by some 
other cathartic. Sometimes, when it is exhibited with a view to a 
full action on the liver, gr. J^-ij may be taken every hour or two 
until the whole purgative dose is taken ; or it may be administered 
at bedtime, with an aperient draught the next morning, as a Seidlitz 
powder. For children, larger doses are required in proportion 
than for adults: gr. %-vj maybe given to a child from three to six 
years old. Calomel occasionally causes griping pains in the bowels, 
with bilious vomiting ; this is attributable, not to any irritant quali- 
ties in the medicine, but to the acrid character of the bile secreted. 
Calomel is an ingredient of the compound cathartic pills. 

Massa Hydrargyri [Mass of Mercury), commonly called blue pill 
or blue mass (see Alteratives), is analogous in its cathartic action 
to calomel, but milder and less certain. It is given in about the 
same doses and in the same combinations, etc. 

ENEMATA. 

In cases of irritabillity of the stomach — or with the view of 
hastening the action of cathartics taken by the mouth — or to remove 
feculent accumulations in the lower bowels — or to relieve tympan- 
ites — or for the purpose of revulsion, or the removal of thread- 
worms — or as astringents in intestinal fluxes, as emollients to soothe 
the lower bowel, or as restoratives, and finally as sedatives, enemata 
are frequently administered. They may be conveniently classified 



CA THAR TICS— ENEMA TA. 375 

into purgative, forced, anthelmintic, astringent, emollient, nutrient, and 
anodyne. 

1. Purgative Enemata. — When it is desired simply to open 
the bowels mechanically, as in obstinate constipation, peritonitis, etc., 
tepid water, flaxseed tea, or other demulcent infusion may be em- 
ployed. The common laxative enema consists of a tablespoonful 
of common salt, molasses and lard-or olive-oil, each, in two-thirds 
of a pint of warm water ; castor-oil or Epsom salt may be added to 
increase the cathartic effect. Senna-tea or some other cathartic in- 
fusion is often employed. Glycerin, f3ss-j, with an equal quantity 
of water, injected into the rectum, will produce in a few minutes, an 
evacuation, usually normal in consistence. To relieve flatulency , oil 
of turpentine (fsss-j, in emulsion), or milk of asafcetida (f5ij-iv) 
may be given. The latter is a suitable preparation in infantile cases. 

2. Forced Enemata. — In some cases, as intussusception of the 
intestines, or even in hernia, much good may be accomplished by 
the gradual distention of the bowel by means of forced enemata of 
warm water. This is accomplished by means of a long flexible 
rubber-tube, one end of which is armed with a rectal tube having a 
blunt conical point and several large openings to admit of the free 
passage of the water. The other end of the flexible tube is attached 
to a large funnel, and the tube has a stop-cock upon it. By elevat- 
ing the funnel and filling it with water, a continual stream can be 
thrown into the bowel, the force being regulated by the height at 
which the funnel is held and by the stop-cock. In this way from 
five to ten pints of water can be thrown into the bowel, filling the 
large intestine and even passing the ileo-csecal valve. The injection 
should be conducted slowly and carefully. Several cases of intus- 
susception have been reported where the symptoms subsided under 
this treatment, the invaginated portion of the intestine having slipped 
back to its proper place during the distention. This method should 
not be resorted to when there is reason to think that sphacelus of 
the bowel is taking place, as it might result in a rupture. 

3. Anthelmintic Enemata. — For the removal of thread-worms 
infusion of quassia makes an excellent enema. For the same purpose 
injections of salt and water, oleum terebinthinae f5iv-vj with the 
yolk of an egg in a pint of tepid water, or lime-water alone, are 
serviceable remedies. 

4. Astringent Enemata. — These are employed to arrest hem- 
orrhage as in hemorrhoids, to cure chronic dysentery and diarrhoea, 



376 MATERIA MEDICA AND THERAPEUTICS. 

to restrain muco-intestinal discharges, as in proctitis, and to heal 
rectal ulcers. Ice-cold water injections are employed against hemor- 
rhage. Nitrate of silver gr. ij-v to water Oj, zinc sulphate, or alum 
gr. iv-viii to water Oj are suitable therapeutical measures for the 
relief of cases of dysentery and diarrhoea that have resisted other 
methods of treatment. The silver-enemata is also applicable to the 
healing of ulcers. For piles the decoctions of white oak-bark, 
geranium and hamamelis are applicable; in chronic proctitis silver 
nitrate gr. v-xx, water f§i ; or tannin gr. v- io to water f§ ; both to 
be introduced through a long tube. 

5. Emollient Enemata — These are employed to relieve inflam- 
mation and irritability of the rectum and lower bowel. For this 
purpose decoctum lini, mucilago ulmi, decoctum cetrariae and de- 
coctum chondri are used. They are besides nutritious, particularly 
the two last. 

6. Nutrient Enemata — In cases of exhaustion and hemorrhage 
as in scirrhus of the pylorus, gastro-intestinal dilatation, gastric ulcer ; 
gastritis, the following substances may be injected daily as restora- 
tives, viz., beef-tea giv-viij with HC1 Tilx and glycerole of pepsin 
Sij, defibrinated blood (see p. 75); milk and gruel; beef-tea and 
brandy. Pancreation may be advantageously added to the above, 
and if the injection be intolerant, a little laudanum. 

7. Anodyne Enemata — These are administered in painful 
affections of the rectum, bladder, vagina and urethra as follows ; 
laudanum f 5^-j ; tinctura belladonna gtt. xv-xxx ; cocaine gr. %S 
j, to water f§ij-iv. 

ORDER III.— DIAPHORETICS. 

Diaphoretics (from dcayopew, I transpire), called also sudorifics, 
are medicines which promote transpiration from the skin. The ac- 
tion of the cutaneous exhalants maybe increased by various means. 
The mere introduction of a large quantity of fluid into the system 
will produce sweating, if the system be kept warm. Exercise, and 
a warm temperature, by determining a flow of blood to the cutaneous 
vessels, act in the same way. Nauseants occasion diaphoresis by 
relaxing the orifices of the cutaneous vessels ; stimulants, by excit- 
ing them to increased secretion. Diaphoretics are employed thera- 
peutically for their evacuant, revulsive and alterative effects, and to 
promote absorption. Different classes of diaphoretics are required 
for different morbid conditions. 



DIA PHORE TICS—PIL O CARPLS. 377 

I Nauseating Diaphoretics.— Most of the emetics in nauseating 
doses, produce a powerfully relaxing diaphoretic action, and are 
much employed, with this view, in inflammatory cases, when not 
contraindicated by the presence of gastric irritability. The Pre- 
parations of Antimony (q. v.) and Ipecac (q. v.) are chiefly re- 
sorted to as nauseating diaphoretics. Ipecac is often given as a 
diaphoretic, in combination with opium, in the form of Dover's 
Powder (see p. 89). 

2. Refrigerant Diaphoretics. — The saline and ethereal pre- 
parations classed as refrigerants (q. v.), produce a gentle relaxing 
diaphoretic action, unattended with nausea. They are used to allay 
febrile excitement and reduce the temperature of the body. 

3. Stimulating Diaphoretics. — This group includes the dif- 
fusible stimulants, aromatic substances generally, of every class, and 
many narcotics, particularly opium and camphor. They are contra- 
indicated in high inflammation, but are very serviceable in rheu- 
matic and pulmonary affections, after vascular excitement has been 
reduced, and in all diseases where the surface of the body is cold. 
Opium, in the form of Dover's Powder, may be employed in inflam- 
matory cases, where other stimulating diaphoretics are inadmissible, 
and is given with advantage in an early stage of acute rheumatism, 
dysentery and catarrh of the air passages, unless the action of the 
pulse be very strong, when this should be previously moderated. 
The operation of the diaphoretic stimulants is promoted by the free 
use of warm diluent drinks, and warm covering to the body. 

pilocarpus. 

Pilocarpus is the leaflets of Pilocarpus pennatifolius (Nat. 
Ord. Rutaceae), a shrub of some of the northern provinces of Brazil, 
growing to the height of about five feet, with a long cylindrical root, 
about three-quarters of an inch in thickness, and imparipinnate 
leaves (with anastomosing veins near the margin) about nine inches 
long, with from three to five pairs of opposite, oblong-lanceolated, 
grayish-green leaflets, with an odd terminal one, which are dotted 
with a number of pellucid glands. There are several plants known 
in South America under the name of Jaborandi, and the variety 
brought here is from Pernambuco. The leaflets have a characteristic 
odor (resembling a mixture of Indian hemp, matico and cubebs) and 
a warm, sharp, aromatic taste. 

Chemical Constituents. — They yield pilocarpine (CuH 16 N 2 2 ), 



378 MATERIA MEDICA AND THERAPEUTICS. 

an alkaloid of a bitter, nauseous, astringent taste, soluble in water, 
alcohol, ether, chloroform and diluted acids, and an amorphous 
alkaloid termed Jaborine * — probably a derivative of pilocarpine — 
has been isolated, which resembles atropine in action; they contain 
also a volatile oil (chiefly pilocarpine, C 10 H 16 ). Recently MM. Hardy 
and Calmels f have obtained pilocarpine synthetically from a deriva- 
tion of pyridin, which is stated to be identical in action with the 
natural base. 

Incompatible^. — Tannic acid, the caustic alkalies, the ferric 
and metallic salts. 

Fig. 44. 




B 
PILOCARPUS PENNATIFOLIUS. A, LEAF ; B, C, FLOWERS. 

Aids. — As a diaphoretic, sarsaparilla and mezereum; upon the 
heart by aconite, veratrum viride, etc. 

Contraindications. — Pilocarpus should not be given in affec- 
tions of the gastro-intestinal mucous membrane, nor in weak heart 
due to disease of the cardiac muscle or ganglia, or of the valves. 

Physiological Effects. — The action of pilocarpus and of its 
alkaloid (upon which its effects depend) has been studied by 
Ringer, J Murrell, Langley,§ Harnack and Meyer (loc. cit) and many 
others, with the following results. It paralyzes the vaso-motor 
nervous system, and rapidly excites the circulation, but the pulse is 



* Arch, fur exper. Pathol, u. Phurmakol., XII, p. 366 ; Harnack und Meyer. 

I Compt. Rend. CII, quoted in Dublin M. J., Dec., 1887. 

% Practitioner, 26, 1881, p. 5. IJourn of Physiology, 1878, p. 339. 



DIA PHORE TICS- PI L O CA RPUS. 37 9 

soon slowed and the arterial tension is greatly diminished. Accord- 
ing to Ringer (Joe. cit.), it paralyzes the ventricles separated from the 
auricles by a direct action. The temperature, as a rule, rises at 
first, but coincident with the profuse sweating, is lowered. It is a 
powerful diaphoretic, augmenting both the watery and solid ingre- 
dients of the sweat enormously, probably by a direct action on the 
peripheral endings of the nerves. The amount of urea eliminated 
by the skin is especially heightened. The sweat is said to be acid 
at first, becoming neutral and, finally, alkaline. It also causes sali- 
vation, which is sometimes very profuse, in which case the diapho- 
retic effect is less marked, and vice versa. The sialagogue effect 
probably depends on a direct action of the drug upon the glands. 
The gastric and bronchial secretions are also increased. These 
effects continue for from three to six hours. Disturbance of the 
vision, contracted pupils, cerebral uneasiness, and after a time, 
vomiting, generally accompany these eccritic results, which effects 
are often followed by drowsiness. In much of its action, especially 
on the secretions, an antagonism exists between pilocarpus and 
belladonna (Langley, loc. cit.). Pilocarpus appears to stimulate the 
nutrition of the hair, and in one case, Prentiss,* under its use, 
noticed a change in the color of the hair from blonde to black. 
Galezowskif found that an aqueous solution of pilocarpine nitrate 
applied to the conjunctiva contracted the pupil. It is eliminated 
by the secretions on which it acts. 

Medicinal Uses. — In cases of pleuritic effusion, especially after 
the subsidence of the inflammatory symptoms, pilocarpus or its 
alkaloid often quickly removes the transudation. In the renal dropsy 
and uremia of chronic Bright s disease it is frequently invaluable 
on account of its diaphoretic effects and because it increases the 
elimination of urea by the skin. It has also been used with success in 
puerperal eclampsia due to kidney disease, in humid asthma and bron- 
chorrhtxa, in some cases of mumps , in chronic enlargeme7it of the 
cervical glands, in adenitis of the inguinal glands, and as a galacta- 
gogue. Pilocarpine has been found useful in arresting severe and pro- 
longed hiccough, in doses of gr. y^ hypodermically employed. It is 
recommended in diabetes insipidus and in squamous affections of the 
skin, as phthiriasis and psoriasis, and has been used locally and hypo- 



* Phila. Med. Times, July 2d, 1881. 

f Comptes Rendus de la Societe de Biologie, 4, 1877, p. 401. 



380 MATERIA MEDICA AND THERAPEUTICS. 

dermically with advantage in alopecia. In diphtheria it has been given 
with varying success, but on the whole the evidence can scarcely be 
considered in favor of its employment. By reason of its diaphoretic 
action it is one of the remedies used in anidrosis. 

Administration. — Dose of the fluid extract, f5ss-j ; of pilo- 
carpine hydrochlorate, gr. J^-ss. Children bear proportionally large 
doses. 

ALTERATIVE DIAPHORETICS. 

Under this head are comprised a class of diaphoretic medicines 
which produce a gradual and nearly insensible increase of the cuta- 
neous secretion, and are supposed to promote the elimination of 
noxious matters from the blood through the vessels of the skin. 
They are employed chiefly in chronic rheumatic and cutaneous 
affections, and in secondary syphilis. 

SARSAPARILLA. 

The name of Sarsaparilla is applied to the root of Smilax offi- 
cinalis, S. medica and other species of Smilax {Nat. Ord. Smilaceae), 
twining prickly shrubs of Mexico, Guatemala and the warm coun- 
tries of South America. 

Description and Varieties. — The roots consist of numerous 
wrinkled, slender pieces, of the average thickness of a writing-quill, 
several feet long, springing from a common head or rhizome, and are 
frequently found in the shops with portions of the stem attached. 
Several varieties are known: l. Hondicras sarsaparilla, the most 
common variety in the United States, is composed of several long, 
thin roots, folded lengthwise, of a dirty grayish or reddish-brown 
color. 2. Jamaica sarsaparilla, which comes in shorter bundles, 
and is known by the red color of the epidermis. 3. Vera Cruz 
sarsaparilla consists of a head with numerous long radicals. 4. 
Brazilian or Rio Negro sarsaparilla is found in cylindrical bundles, 
with fewer rootlets than the Honduras variety ; it is distinguished 
by the amylaceous character of its interior structure. 5. Guatemala 
sarsaparilla resembles Brazilian. 

Sarsaparilla roots are several feet in length, about the thickness 
of a goose-quill, cylindrical, more or less wrinkled longitudinally, 
and consist of a whitish-brown or pink cortical portion covered with 
a thin, gray, brown or red epidermis, and inclosing a layer of whitish 
ligneous fibre and a central pith. The cortical portion is more active 
than the interior portion ; the central medulla contains a good deal 



DIAPHORETICS— GUAIACUM WOOD. 381 

of starch. Sarsaparilla, in the dried state, is nearly inodorous, but 
its decoction has a strong smell. It has a mucilaginous, slightly 
bitter taste, and when chewed for some time produces a persistent 
acrid impression on the mouth ; this acridity of taste is the criterion 
of good sarsaparilla. 

Chemical Constituents. — Water and diluted alcohol extract 
its virtues. It contains three homologous* glucosides, resembling 
saponin, called smilacin, parallin and sarsasaponin, a volatile oil y 
etc. The Vera Cruz and Jamaica varieties contain the most smi- 
lacin, and are therefore the best for medical purposes. 

Aids. — Guaiac, mezereum and pilocarpus. 

Effects and Uses. — The physiological effects of sarsaparilla, 
which depend on its glucosides, beyond an increase in the flow of the 
secretions, are not very obvious ; in large doses it produces nausea, 
vomiting, diarrhcea and salivation. Its efficacy in eradicating vari- 
ous morbid symptoms is believed in by some, though denied by 
others ; and its mode of action, which resembles the mercurials in 
certain points, is popularly attributed to a purifying influence on 
the blood through the function of the skin. It is employed in sec- 
ondary and tertiary syphilis, particularly where the disease resists or 
is aggravated by the use of mercury ; also in chronic rheumatism, 
skin-diseases, as eczema pustulositm, and cachectic conditions of the 
system generally. 

Administration. — Dose, of the powder, 5ss three or four times 
a day — never used, however, in this form. The compound decoction 
is made by boiling sarsaparilla 10 parts, sassafras, guaiacum wood 
and liquorice root each 2 parts, and mezereon 1 part, in 100 parts of 
water, then macerating, and, after straining, adding water enough to 
make the decoction measure 100 parts: dose, foiv-vj t d. The 
compound syrup (which contains also guaiacum wood, pale rose, 
senna, glycyrrhiza, sassafras, anise, and gaultheria) is a favorite 
preparation ; corrosive sublimate should not be given with it, as it 
is decomposed, it is said, into calomel. Dose. f§ss. Of the fluid 
extract, the dose is f 5ss. The compound fluid extract contains the 
ingredients of the compound decoction, except the guaiacum ; 
dose, f§j, repeated. 

guaiaci lignum— guaiacum wood, 
guaiaci resin a— guaiac. 

Guaiacum Wood, or Lignum Vitce, and Guaiac are products of 

* Dissert. Inaug. Dorj>at, 1892, Schultz, quoted. 



382 MATERIA MEDICA AND THERAPEUTICS. 

Guaiacum officinale and G. sanctum (Nat. Ord. Zygophyllacege), 
large evergreen trees of South America and the West Indies. The 
wood, which is remarkable for its hardness and density, is imported 
in logs or billets, covered with a thick gray bark ; the outer portion 
or sap-wood is of a pale-yellow color, the inner of an olive-brown. 
The heart-wood is the official portion ; it is usually kept in the 
shops in the state of shavings or raspings ; they are inodorous unless 
heated, and when chewed for some time they have a bitterish pun- 
gent taste. Guaiacum wood yields its virtues to alcohol, and partially 
to water ; they depend on the guaiac contained in the wood. 

Preparation and Chemical Constituents. — Guaiac is a pe- 
culiar resin, obtained from Guaiacum officinale by- spontaneous 
exudation, by incision, by dry heat, or by decoction of the com- 
minuted wood. It comes in large, irregular, semi-transparent, 
brittle pieces, of varying size — externally of a deep green or olive 
color, and internally red. It has a slight balsamic odor, which is 
rendered stronger by heat, and though at first nearly tasteless, 
leaves a hot, acrid sensation in the mouth and throat. Water dis- 
solves it partially, alcohol completely. It contains guaiaconic and 
guaiaretic acids, guaiac beta-resin , gum, ash, guaiacic acid, coloring 
matter, etc. (Hadelich*). Most oxidizing agents, as nitric and chro- 
mic acids, etc., produce a blue, then green, and finally a brown 
color, with tincture of guaiacum. 

Incompatibles. — Spirit of nitrous ether and the mineral acids; 
water decomposes the resin. Oxidizing agents produce a play of 
colors with the tincture. 

Aids. — Sarsaparilla, mezereum, and pilocarpus. 

Effects and Uses. — Guaiacum wood and guaiac are stimulant 
diaphoretics, also increasing the secretion of the bronchial mucus, and 
in large doses, cathartic. They are principally used for their alleged 
alterative virtues in chronic rheumatism, rheumatic arthritis, and skin 
diseases ; guaiac has been used as a laxative. In acute tonsillitis the 
tincture, f5/4, repeated every three or four hours, is extremely use- 
ful. They are considered also to possess emmenagogue properties, 
and are employed in amenorrhcea and dysmenorrhoea. 

Administration. — Guaiacum wood is used only as an ingre- 
dient in the compound decoction and syrup of sarsaparilla. Dose 
of guaiac, gr. x-xxx, in pill or emulsion, sometimes combined with 
alkalies. The tincture (20 parts in 100 parts of the tincture) and 

*" Pharmacographia," 2d ed., p. 104, quoted. 



DIAPHORE TICS—MEZERE UM. 383 

ammoniated tincture (20 parts to aromat. sp. of ammonia q. s. to make 
100 par's) are much used in chronic rheumatism; the former is 
given also in amenorrhcea; dose, foj t. d. They are decomposed 
by water, and should be administered in mucilage, syrup or milk, 
or emulsified with acacia. 

MEZEREUM. 

Mezereum is the bark of Daphne mezereum and other species 
of Daphne (Nat. Ord. Thymelaceae), European shrubs which grow 
to the height of four or five feet. The root-bark is the part employed 
in Great Britain, but the bark of our shops, which is brought from 
Germany, is the stem-bark. It comes in strips from two to four 
feet long and an inch or less in breadth, folded in bundles or 
wrapped in the shape of balls. It has a thin grayish or reddish- 
brown, wrinkled epidermis and a tough, pliable, whitish inner bark. 
When fresh it has a faint, nauseous smell, but when dry is nearly 
inodorous. Its taste is at first sweetish, afterward highly acrid. 

Chemical Constituents. — It yields its virtues to water and 
alcohol, and contains a neutral crystalline bitter glucoside, called 
daphnin (C 31 H 34 19 ), and a resin, to which it owes its acridity. 

Incompatibles. — Tannic and free acids precipitate the gluco- 
side. The resin is insoluble in water. 

Aids — Sarsaparilla and guaiac. 

Toxicology. — Christison* records a case of fatal poisoning in 
a child of 8 years by mezereon, but the quantity taken is not men- 
tioned. 

Effects and Uses. — The topical action of mezereum is irritant 
and vesicant. When swallowed in large quantities it is highly 
acrid ; in medicinal doses it promotes the action of the secreting 
and exhaling organs, particularly of the skin and kidneys. 

It is employed chiefly in conjunction with sarsaparilla, (in the 
compound decoction, etc.) as an alterative diaphoretic in rheumatic 
syphilitic and cutaneous affections. As a masticatory, it has been 
chewed for the relief of paralysis of the muscles of deglutition. 

Administration. — The fluid extract is the best preparation for 
internal administration ; dose, Tfl,x. An extract is also official, and 
is given as an addendum to rubefacient liniments and ointments. 
The ointment is also used as a stimulating application to indolent 
ulcers. Mezereum is rarely employed nowadays. 

* ''A Treatise on Poisons," 4th ed., p. 601. 



384 MATERIA MEDICA AND THERAPEUTICS. 



MENISPERMUM. 

Menispermum is the rhizome and rootlets of Menispermum 
canadense, Yellow Parilla or Canada Moonseed {Nat. Ord. Meni- 
spermaceae), a climbing plant of North America. The rhizome con- 
tains berberine, starch, etc. It is supposed to be a diaphoretic, 
diuretic, tonic and alterative, and to possess virtues similar to those 
of sarsaparilla, and it may be given in corresponding doses. Accord- 
ing to the experiments of Rutherford, it is an intestinal, but not an 
hepatic, stimulant. There are no official preparations. 

CALENDULA. 

Calendula is the fresh flowering herb of Calendula officinalis, 
or Marigold [Nat. Ord. Composite), a European plant, cultivated 
in our gardens. It contains a volatile oil, a bitter-principle, calen- 
dulin, etc. It is supposed to be stimulant, alterative, diaphoretic, 
and diuretic. It is said to be efficacious in certain forms of chronic 
vomiting, and externally it is prescribed to promote resolution of 
ulcers and wounds. It may be given in doses of gr. viij-5j. Of the 
tincture, the dose is f5ss-j. It maybe used externally, diluted with 
water 20 parts. 

SASSAFRAS. 

This is the bark of the root of Sassafras officinale (Nat. Ord. 
Lauraceae), an indigenous tree of middling size. The bark is found 
in the shops in small, irregular pieces, of a cinnamon-color, some- 
times invested with a brownish epidermis. It has a highly fragrant 
odor and a sweetish, aromatic taste. Its virtues are extracted by 
water and alcohol, and it contains a little tannic acid and a volatile 
oil (oleum sassafras). 

Effects and Uses. — Sassafras bark is a mild stimulant altera- 
tive diaphoretic, used chiefly in combination with sarsaparilla. Its 
principal virtues are probably aromatic. Dose of the oil, gtt. ij-x. 
(For Sassafras Pith, see Demulcents.) 

stillingia. 

The root of Stillingia sylvatica (Nat. Ord. Euphorbiacese), 
commonly called Queen's Delight, a perennial plant growing to the 
height of two feet in our south Atlantic States. Its active princi- 
ple has not been isolated. 



DIURETICS. 385 

Effects and Uses. — The juice of the plant possesses a biting 
pungent taste, which, when swallowed excites a feeling of warmth in 
the stomach. It augments the secretions of the gastro-intestinal 
tract, particularly the liver, also the urinary flow, and in full doses 
nauseates and purges. It is highly esteemed by southern physi- 
cians as an alterative diaphoretic in secondary syphilis ■, scrofula, cuta- 
neous affections and chronic rheumatism. 

Administration. — Dose of the powder, gr. xv-xxx. The fluid 
extract may be given in the dose of f5ss. A decoction and tinc- 
ture are extemporaneously prepared. 

ORDER IV.— DIURETICS 

Diuretics (from did, thoroughly, and oupicu, I make water) are 
medicines which excite the secretion of the urine. The flow of urine 
may be promoted indirectly by increasing the quantity of fluid taken 
into the stomach, or by the removal of causes which check its secre- 
tion, or by mental emotion, a cool temperature, etc. It is promoted 
directly by the use of medicinal agents which specifically affect the 
kidneys ; they are termed diuretics. A large proportion of diuretic 
medicines are found among the agents which influence other secre- 
tions, particularly diaphoretics. The functions of transpiration and 
urination are to some extent vicarious, and the same articles will 
prove diaphoretic or diuretic, as their action may be directed to the 
skin or kidneys. External warmth and warm drinks determine the 
action of such medicines to the skin ; and, on the other hand, if the 
skin be kept cool, and cool diluents freely administered, the secre- 
tion from the kidneys is promoted. 

Blennorrhetics \ or medicines which have a special action on the 
mucous membranes, exert also a diuretic influence — probably the 
result of the stimulating impression which they make on the mucous 
membrane of the urinary passages. When the action of the kid- 
neys is obstructed by diseases of the heart, sedatives prove diuretic, 
by their tranquillizing influence on the action of the heart. In cases 
of obstruction of the portal system, mercurials increase the efficacy 
of the diuretics proper ; and also cathartics, by stimulating the flow 
of bile and the pancreatic juice. 

The principal therapeutic employment of diuretics is to promote 

the absorption of dropsical effusions. They are also useful in nephritic 

disorders attended with obstructed secretion ; to wash out calculi 

from the pelvis of the kidneys, ureters and bladder; in gravel, with 

25 



386 MATERIA MEDIC A AND THERAPEUTICS. 

the view of rendering the urine more dilute; and they may be re- 
sorted to as evacuants, to reduce inflammation. 

As diuretics act by becoming absorbed, they should be admin- 
istered in a very diluted state, to prevent a cathartic effect. 

The following groups of medicines, noticed under other heads, 
are employed also as diuretics : — 

1. The Saline and Ethereal Refrigerants (see p. 255 ). 

2. The Alkaline Carbonates (see Antacids) ; and the Alkaline 
Salts which contain a vegetable acid, as the acetates, citrates and tar- 
trates. The acid potassium tartrate, or cream of tartar (see p. 346), 
is a very active diuretic. 

Potassii Acetas (Potassium Acetate). This sail ' (KC 2 H 3 2 ), for- 
merly termed sal diureticus from its decided diuretic action, is made 
by saturating acetic acid with potassium bicarbonate. It occurs, 
when pure, as a white, foliaceous, satiny mass, of a warm, pungent 
taste, very deliquescent, and wholly soluble in water and alcohol. 
The physiological effects of the potassium compounds have already 
been fully considered (see p. 253). In small doses it is diuretic, and 
in larger doses gently cathartic. It is a good deal employed as a 
diuretic in dropsies, to cleanse the kidneys of deleterious matters in 
pyelonephritis, as an antacid in acute rheumatism, as a preventive of 
the formation of uric acid calculi f and it has also been found useful 
as an alterative in cutaneous affections. As is the case with all the 
alkaline salts containing vegetable acids, the acidulous radical of 
this salt is decomposed in the system into carbonic acid. Although 
increasing the flow of urine, potassium acetate diminishes the 
amount both of uric acid and of urea in the secretion. Hence, it 
is valuable in gout, and, like colchicum, it may perhaps check the 
actual formation of uric acid in the system. Dose, gr. xx-5j, 
repeated. 

Sodii Acetas (Sodium Acetate) (NaC 2 H 3 2 .3H 2 0) 7 is prepared 
from crude pyroligneous acid, which is saturated with cream of 
lime, and the solution of calcium acetate thus formed is decomposed 
by sodium sulphate ; repeated solution and crystallization, with 
fusion, furnish a pure salt in the form of white or colorless striated 
prisms, which effloresce in dry air, are wholly soluble in water, toler- 
ably soluble in alcohol, and have a sharp, bitterish, not disagree- 
able taste. Its effects and uses are analogous to those of potassium 
acetate, over which it has the advantatage of not being deliquescent. 
Dose, gr. xx-5j, p. r. n. 



DIURETICS— SQ [/ILL. 387 

3. Sedatives (see p. 235) ; and Digitalis (see p. 277), which is 
very much employed in cardiac dropsies in combination with squill. 

4. Blennorrhetics (see index), particularly the oleo-resins. 

5. Most of the Stimulating Diaphoretics. 

SPECIAL DIURETICS. 
SCILLA— SQUILL. 

Squill is the sliced bulb of Urginea Scilla (Nat. Ord. Liliaceae) 
a perennial plant which grows on the shores of the Mediterranean. 
It has fibrous roots attached to a roundish-ovate bulb, from which 
both the leaves and flower-stem spring directly, the latter appear- 

FlG. 45. 




URGINEA SCILLA, BULB. 



ing first ; the leaves are broad, lanceolate, and from twelve to eigh- 
teen inches long ; the stem is about two feet high, and bears pale 
yellowish-green flowers. 

The fresh bulb is pyriform, of the size of a fist to that of a 
child's head, and consists of thick, fleshy, concentric scales, atten- 
uated at their edges, and attached to a rudimentary stem ; the outer 
scales are very thin and papery. Two kinds of squill bulbs are 
met with, the white and the red, which differ only in the color of 
their scales, and are identical in medicinal virtues. Both abound in 
a viscid, acrid juice, which is very much diminished by drying, with 
little loss of medicinal power. . For importation, squill is usually 
sliced and dried, and is found in the shops in white or yellowish- 



388 MATERIA MEDICA AND THERAPEUTICS. 

white pieces, which when dry are brittle, but when moist, flexible. 
They absorb moisture readily, and should be kept in well-stoppered 
bottles. They have a feeble odor, a bitter, nauseous, acrid taste, 
and yield their virtues to water, alcohol and vinegar. 

Chemical Constituents. — The active principles found in squill 
are scillipicrin, scillitoxin, and scillin. The first two are said to act 
on the heart like digitalis, slowing the pulse by stimulating the end- 
organs of the par vagum, and the last to produce numbness and 
vomiting. A principle termed scilldin is described by Jarmersted,* 
which he ascertained to be poisonous to the heart-muscle. 

Aids. — As an expectorant, senega and tartar emetic ; digitalis 
promotes its diurectic action. 

Physiological Effects. — In small doses, squill promotes se- 
cretion from the mucous membranes and the kidneys — its diuretic 
effect being much the most marked and constant. Hammond | 
found that in addition to its diuretic action, it increased also the pro- 
portion of inorganic solids. Husemann states that the diuretic 
effects of squill are due to its influence on the food-pressure, which 
it increases; but clinical experience teaches that it stimulates the 
kidneys. In large doses it excites .nausea, vomiting, and occasionally 
purging. 

Toxicology and Antidotes. — In excessive doses it acts as an 
acro-narcotic poison, gr. xxiv); having proved fatal. The symp- 
toms are violent vomiting and purging, abdominal pains, bloody or 
suppressed urine, reduction of the pulse, with collapse ; or death 
may be preceeded by convulsions. Christison § describes an in- 
stance in which a teaspoonful of the root killed a woman, the chief 
symptoms being gastric pain and convulsions. The stomach was 
found to be inflamed everywhere, and partly eroded. After evac- 
uation of the stomach, opiates and demulcents are to be adminis- 
tered, and, if syncope or collapse occur, alcoholic stimuli should be 
given. 

Medicinal Uses. — Squill is employed principally in the treat- 
ment of dropsy ; it should not be used, however, in cases compli- 
cated with degeneration of the kidneys or inflammation of the blad- 
der. Digitalis is much prescribed in combination with squill in the 

* Arch, fur exper. Pathol, u. Pharmak., XI, p. 22. 
-f Am. Jo-urn. Med. Set., 1859, p. 275. 
% " Handbuch der Toxicologic," p. 413. 
$ '' A Treatise on Poisons,'' 4th ed., p. 879. 



DIURETICS— COLCHICUM. 389 

treatment of cardiac dropsies, and calomel is often added with a 
view to its action on the absorbents. As a blennorrhetic expectorant, 
squill is an excellent remedy in chronic and acute broiichial affections ; 
it is, however, improper in the early stages of inflammatory cases. 
As an emetic, squill is too dangerous for general use ; but it forms 
an ingredient in some emetic preparations administered in croup. 

Administration. — Dose, as a diuretic or expectorant, gr. j, re- 
peated and gradually increased till nausea supervenes. Grains vj-xij 
will induce emesis. Of the vinegar (acetum scillcz, containing 10 
per cent, by weight of the powder), the dose is Tfl.xv to f^ij ; of the 
fluid extract, TTlj ; of the syrup, f3j ; of the compound syrup, known as 
hive syrup (which contains a solution of senega and squill in diluted 
alchohol and water, and tartar emetic, gr. j in every ounce of the 
syrup), Tflv-fjj, according to the age; of the tincture, Tttv-xxx; 
the last three are excellent preparations in the latter stages of acute 
bronchitis. 

COLCHICUM. 
Colchici Radix, Colchicum Root; Colchici Semen, Colchicum Seed. 

Colchicum autumnale, or Meadow- Saffron {Nat. Ord. Melan- 
thaceae), is a small biennial, bulbous plant, which grows wild, in 
moist meadows, in England and other temperate parts of Europe. 
The bulb, or corm, appears in midsummer as the lateral offset from 
the corm of the preceding year, and sends up the flower-stem in the 
autumn — the leaves and fruit following in the succeeding spring. 
The leaves are broadly lanceolate, about five inches long; the 
flowers, of a lilac or light-purple color; and the fruit, oblong, 
elliptical and three-celled. 

Description. — The corm and seed are the portions used medi- 
cinally. The corms are gathered in July, just before the sprouting 
of the flower from the young corm. They are somewhat like tulip- 
bulbs in appearance, but solid, and not composed of scales. They 
are covered by an external brown membrane and an inner reddish- 
yellow one, and are an inch and a half to two and a half inches in 
length, with a longitudinal groove. Internally they are white, fleshy 
and solid, and ntain an acrid, bitter, milky juice. As found in the 
shops they are in the dried state, sometimes whole, but usually 
cut into transverse slices, about an eighth of an inch thick, with a 
notch on one side, and deprived of the outer brown membrane. 
They have a hircine odor and a bitter, hot and acrid taste. The 
seed are brown, about the size of black-mustard seed, inodorous, 



390 MATERIA MEDICA AND THERAPEUTICS. 

and have a bitter, acrid taste; they are less apt to be injured by 
drying than the corm. 

Chemical Constituents and Tests. — Colchicumcorm and seed 
yield their virtues to vinegar and alcohol ; they both contain an al- 
kaloid, soluble in water, readily so in alcohol, but insoluble in ether 
termed colchicine (C 23 H 27 N0 7 , Laborde et Houde), on which the 
medicinal activity depends. Colchicine (C 46 H 2r N0 14 ) is a crystalline 
substance, of feeble acid reaction, which does not preexist in the 
plant, but is formed by the action of the mineral acids upon col- 
chicine. Tests. — Colchicine makes with concentrated nitric acid a 
play of colors, beginning with yellow, then green, afterward crim- 



FlG. 46. 




COLCHICUM AUTUMNAI.E, BULB. 



son, and finally violet ; with concentrated sulphuric acid, to which 
has been added a fragment of potassium nitrate ; it produces an 
intensely yellow color terminating in light violet. 

Incompatibles.- — Tannic acid, and the vegetable infusions con- 
taining it, form a partly insoluble tannate with colchicine. - 

Aids. — Squill; also the purgatives, and diuretics, as colocynth 
and digitalis. 

Physiological Effects. — Colchicum is a local irritant. Col- 
chicine is undoubtedly the active ingredient of meadow-saffron 
(Huseman*), and when introduced by the stomach diffuses into the 
blood, since it has been found in the heart, lungs, liver, kidneys and 

•^''Die Pflanzenstoffe," 1871, p. 497. 



DIURE TICS— COL CHI CUM. 391 

blood by Aschoff.* Other observers, however (Laborde et Houdef) 
failed to detect it there or in the heart, even after intravenous injec- 
tion, but found the largest quantity inside the stomach and intes- 
tines. It seems to expend its force on the alimentary tract, though 
not entirely by a local action, for both LewinsJ and Roy § found 
these parts to be much inflamed after the subcutaneous administra- 
tion of the drug. Taken internally \ in small doses, it stimulates the 
secretions generally; in larger doses it produces nausea, vomiting,|| 
and repeated purging, and primarily acceleration, followed by a re- 
duction in the frequency of the pulse; in excessive doses it is an in- 
testinal irritant poison, inducing emesis, uncontrollable diarrhoea, 
collapse, and finally destroying life by paralysis of respiration, the 
heart beating for a short time after the cessation of this act ; the 
cerebral functions usually remain unaffected, though Toulmouche 
(loc. cit.) states that there is decided cerebral excitement. Accord- 
ing to the recent investigations of Laborde et Houde (loc. cit) col- 
chicine is without action on the centres of intelligence or volition, 
and there is an entire absence of paralysis, either motor or sensory, 
of central origin. The temperature falls during the period of emeto- 
catharsis; and when injected into dogs there is a marked fall in the 
blood-pressure. The amount of urea and uric acid excreted in the 
urine is much increased after the administration of colchicum. 
Lewins (loc cit) found the urea to be almost doubled. Hammond If 
experimentally ascertained that it heightened the urinary flow and 
the proportion of solids, but as his results were based on only three 
analyses they can scarcely be accepted as conclusive. It increases 
the secretion of the bile, which- at the same time is rendered very 
watery. Although placed among the diuretics colchicum does not 
evince a more decided action on the kidneys than on other secre- 
tions, as those of the skin, liver, and mucous membranes. 

Toxicology. — Dr. Major** reports 17 cases of poisoning by 
the wine of colchicum seeds, seven of which were fatal, the quantity 
ingested ranging from fgiij-viij ; in two, there were convulsions. 



* " Die Pflanzenstoffe," 1871, p. 499, quoted. 

I Pamphlet, 1887. "Le Colchique et la Colchicine." 

% Edinburgh Med. a?id Surg. Jour. LVI, p. 185. 

\ Arch, de Physiol. Norm, et Pathologique, t. V, p. 648. 

|| Arch, Gen. de M'edecine, t. XVIII, p. 37, par. A. Toulmouche. 

\ Atner. Journ. Med. Sci , 1859, p. 275. 

** Canada Med. and Surg. Jour., 1874, p. 24. 



392 MATERIA MEDICA AND THERAPEUTICS. 

Dr. G. B. Wood * states that f 5iiss of the wine of the root proved 
fatal, and in another instance fSiss f of the wine of the bulb killed 
a man. Vomiting and purging are the chief symptoms of colchi- 
cum poisoning, convulsions being infrequent, while the brain 
escapes till the approach of death. After death, in Roy's (loc. cit.) 
experiments upon dogs, the post-mortem appearances were those 
of enteritis. 

Antidotes. — Tannic acid is a partial antidote (forms a white 
precipitate with colchicine) ; emetics if required, and opiates, de- 
mulcents and stimulants are to be given. 

Medicinal Uses. — Colchicum has long enjoyed a high reputa- 
tion in the treatment of gout ; and, although its modus medendi is 
obscure, it is universally admitted to possess a more decided con- 
trol over the disease than any other remedy. It is usually admin- 
istered in repeated doses till an effect is produced on the bowels, 
though purging does not promote its curative effect. Epsom salts 
and magnesia are often combined with it, as in the celebrated 
Scudamore's draught [magnesia, gr. xv-xx ; magnesium sulphate, 
5j-ij ; wine of colchicum seed, f5j-ij, in any ^pleasant vehicle). An 
excellent combination in the treatment of gout is colchicum {wine 
of the seed, f§j), with potassium iodide (5ij), dissolved in cinnamon- 
water (fSviij) ; dose, f§ss t. d. until purgation is produced. Quinine 
and digitalis are also often given advantageously, with colchicum, 
in gout. J When it is desired to act on the kidneys and skin rather 
than the bowels, opiates are sometimes added. It is better to re- 
serve colchicum for the treatment of the acute paroxysms of gout, 
giving a little opium (as in Dover's powder) at night, particularly to 
relieve the pain and procure sleep, enjoining perfect rest and quiet 
and using warm applications locally. In chronic gout and in the 
uric acid diathesis colchicum is not as useful, and these conditions 
are better treated by a properly regulated diet, avoidance of stimu- 
lants, exercise in the open air and the administration of the alkalies, 
particularly of the lithium salts. In rheumatism it is also employed, 
but it has little control over this disease. Dr. Woodbury, § how- 



*" U. S. Dispensatory," 15th ed., p. 1534. 

f Edinburgh Med. and Surg. Journ., XIV, p. 262. 

% Lartigue's celebrated gout-pills are : acetic extract of colchicum root, 2 grains ; ex- 
tract of digitalis, 1 grain ; compound extract of colocynth, 20 grains, to be mixed and divided 
into five pills — one to be taken at night. 

I Phila. Med. Times, Dec. 2d, 1882. 



DIURE TICS—APO C YNUM. 393 

ever, has reported cases where the hypodermic injections of Ttlv of 
a solution of colchicine ( T V per cent.) gave speedy and permanent 
relief in acute rheumatism, after the salicylates had failed. 

It has been occasionally resorted to as a diuretic in dropsy, as 
a sedative in febrile and inflammatory diseases, and as an expec- 
torant. 

Administration. — Dose of the corm or seed, in powder, gr. 
ij-viij ; the seeds are to be preferred. The liquid preparations, 
which are more generally used than the powder, are ; the wine of 
the root (vinum colchici radicis), TTtx-xxx ; wine of the seed (vinum 
colchici seminis), dose. f5ss-j ; tincture (of the seed), dose, f5ss-j. An 
extract of the root (acetic) is also employed — dose, gr. j-ij ; and a 
fluid extract of the seed and also of the root — doses, gtt. iv-xij. The 
alkaloid colchicine (not official) has been recommended as the best 
form of administration in doses of gr. -h in pill, or somewhat less 
by hypodermic injection. 

OLEUM ERIGERONTIS-OIL OF ERIGERON. 

The oil distilled from the fresh flowering herb of Erigeron cana- 
dense, or Canada Fleabane (Nat. Ord. Compositae), an herbaceous 
indigenous plant, two or three feet high, with ovate or lanceolate 
toothed leaves, and white, blue or purple flowers. The oil by dis- 
tillation yields resin and terpene (C 10 H 16 — Power *). 

Effects and Uses. — It possesses diuretic and hemostatic prop- 
erties, and has been used in hemorrhagic dysentery and uterine 
hemorrhage. It has been given in gonorrhoea with success, Stark f 
stating that in the majority of cases it stopped the discharge in from 
two to six days. PrettymanJ reports unvarying success with it in 
50 cases, affirming that it cures in from six to eight days, but as he 
omits the details of treatment, his statement cannot be accepted as 
proven. Dose, gtt. v-xx, on sugar, or in capsule. 

APOCYNUM. 

Apocynum cannabinum, or Canada Hemp (Nat. Ord. Apocy- 
naceae), is an indigenous herbaceous plant growing to the height of 
two or three feet, with oblong-ovate leaves and small greenish, cam- 
panulate flowers. 

*' 4 Pharm. Rundschau," Sept., 1887, p. 201. 

I London Med. Record, June 15th, 1886, quoted. 

\Amer. Jour. Med. Set., 1886, p. 117. 



394 



MATERIA MEDICA AND THERAPEUTICS. 



Description. — The root is the official portion; it is of a yellow- 
ish-brown color when young, and of a dark-chestnut when old, has 
no odor, but a nauseous, acrid, bitter taste. The fresh root, when 
wounded, pours out a milky juice, whence the plant is sometimes 
termed milk-zueed. 

Fig. 47. 




APOCYNUM CANNABINUM. 

Chemical Contituents. — Although the entire root is official, 
the bark of the root is probably alone active. A. androsaemifolium, 
or Dogsbane, is possessed of much the same properties as A. can- 
nabinum. It yields its virtues to water and alcohol, and contains 
gallic and tannic acids, gum, resin, apocynin, apocynein, bitter- extrac- . 



Effects and Uses.- 



sedative, and, in continued doses, 



Canadian Hemp is diuretic, diaphoretic, 
emeto-cathartic. It has been 



DIURETICS— TARAXA CUM. 



395 



shown * to possess a decided cardiac sedative action, analogous to 
that of digitalis ; but without its corresponding elevation of blood- 
pressure. It is chiefly employed in the treatment of dropsy, in which 
its action is often powerfully efficacious. It should be given in 
amounts just sufficient to produce diuresis, when a cathartic effect 
is not desirable. 

Administration. — The best form of exhibition is an infusion 
(5ss to boiling water Oj, or the same amount may be dissolved in 
gin Oj) ; dose, foij-iv three or four times a day. 

TARAXACUM. 

Taraxacum Dens-leonis, or Dandelion (Nat. Ord. Composite), 
is a small herbaceous, perennial plant, common to most parts of the 
world, and found abundantly throughout the United States. 

FIG. 48. 




TARAXACUM DENS-LEONIS. 



Description. — It has a fusiform root, which sends up numer- 
ous long, sinuated, bright-green leaves, and flower-stems about six 
inches high, bearing golden-yellow flowers. The root is the offi- 
cial portion, and should be gathered in the autumn. In the fresh 
state it is several inches long, branched, fleshy, of a light-brown 
color externally, whitish within, and abounds in a milky juice; 
the fresh root is preferable for use. When dried it is shrunken, 
wrinkled and brittle. It is without smell, but has a bitter taste. 

Chemical Constituents. — Boiling water extracts its virtues, 
which probably depend on a peculiar bitter crystallizable principle 



Therapeutic Gazette, Sept. 15, 1889. Geo. R. Murray. 



396 MATERIA MEDICA AND THERAPEUTICS. 

termed taraxacin, soluble in water and alcohol. It also contains 
taraxacerin, resin, and Dragendorff * found inulin and some sugar. 

Effects and Uses. — Taraxacum is diuretic and slightly aperi- 
ent, with some tonic action, and a slight determination to the liver. 
It is useful in hepatic dropsies, and is also employed in dyspepsia 
accompanied by derangement of the liver. 

Administration. — It may be given in the form of infusion — 
dose, f§ij t. d. ; extract (an inspissated juice, which should not be 
kept above a year) — dose, gr. xx-3j t. d.; fluid extract — dose, 
f5j-ij t. d. 

TRITICUM— COUCHGRASS. 

The rhizome of Triticum repens or Couchgrass [Nat. Ord. 
Graminaceae), a perennial weed, native of Europe and North Amer- 
ica, growing in fields and in waste places, with a long, stiff, pale- 
yellow rhizome, which should be gathered in the spring, and is 
found in the shops, freed from the rootlets, cut into short lengths 
and dried, without odor, but having a slightly sweetish taste (Flucki- 
ger and Hanbury), contains triticin (which resembles inulin), and 
several sugars. 

Effects and Uses. — Couchgrass appears to be a feeble diuretic. 
According to Sir H. Thompson, f it exercises a beneficial influence 
in chronic cystitis. He directs the decoction to be made by boiling 
gij-iv in water Oij until reduced to Oj ; the strained liquor to be 
taken in four doses in 24 hours. Whitla, too, advises it to allay 
irritation of the urinary passages. The fluid extract may be given 
in doses of f5ss-j. 

juniperus— juniper. 

The fruit or berries of Juniperus communis {Nat. Ord. Coni- 
ferae), an evergreen European shrub, naturalized in the United States, 
are used as adjuvants to the more active diuretics, and in large 
doses produce strangury and bloody urine, and prove emmenagogue. 
When dried they are about the size of a pea, of a blackish-purple 
color, and a sweetish, terebinthinate, aromatic taste ; they are given 
in infusion. Their virtues depend on a volatile oil (oleum juni- 
peri) (Ci H 16 ), the dose of which is gtt. v-xv two or three times 
a day. 



* " Pharmacographia,' , 2d ed., p. 394, quoted. 

f '* Diseases of the Urinary Organs/' 7th edition, p. 152. 



MURE TICS— C A NTH A RIDES. 397 

Effects and Uses. — Hammond * found that juniper increased 
the flow of urine, the proportion of solids being only slightly altered 
(three experiments). Juniper is employed as a diuretic in the dropsy 
of cardiac, hepatic and chronic renal maladies. Being a stimulant- 
diuretic, it is not adapted to acute affections of the kidneys. 

Administration. — The compound spirit (containing also the oils 
of caraway and fennel, dissolved in alcohol and water) is a pleasant 
addition to stimulating|diuretic and blennorrhetic combinations, and 
a good stomachic and carminative ; dose, f5j-ij. The spirit is made 
by dissolving 3 parts of the oil in 97 parts of alcohol ; dose, f5j-ij. 
An active diuretic mixture is : ^ Potassii bitartratis, 5ij ; seminis 
juniperi, Sj ; aquae (tepid), Oiv. M. Sig. — All to be taken in 24 
hours. 

SCOPARIUS. 

Sarothamnus Scoparius, or Broom [Nat. Ord. Leguminosae), is 
a common European shrub, cultivated in the United States, from 
three to five feet high, with numerous bright-yellow flowers. The 
tops of the branches are the official portion, but the seeds are also 
used. The twigs are pentangular (with small oblong, downy leaves), 
of a bright-green color, a strong, peculiar odor when bruised, and a 
bitter to nauseous taste. 

Chemical Constituents. — Two principles are found in broom- 
tops — scoparin (C 21 H 22 O 10 ), a neutral, crystallizable body, supposed 
to be the diuretic constituent, and a volatile poisonous alkaloid, 
sparteine (CisH^NJ, (vide p. 284) ; it also contains volatile oil, tannin, 
etc. 

Effects and Uses. — Broom is an efficient diuretic, in large 
doses producing free purging. It is a valuable and reliable remedy 
in dropsy, chronic Bright s disease and uremia, best given in decoc- 
tion, half an ounce to a pint of water, boiled down to half a pint, of 
which an ounce may be given every hour or two till the bowels are 
disturbed. A fluid extract is used in doses of f5ss-j. 

cantharis-cantharides. 
The properties, etc., of cantharides will be noted fully under the 
head of Irritants (subdivision Epispastics). Taken internally, they 
sometimes prove diuretic, and generally excite irritation of the 
genito-urinary passages, which is shown by strangury, priapism, etc.; 
and in over-doses act as an acro-narcotic poison. They are employed 

* Amer. Journ. Med. Set., 1859, p. 275. 



398 MATERIA MEDICA AND THERAPEUTICS. 

in dropsies, incontinence of urine, amenorrhcea, seminal weakness, 
impotence, etc. Dose, gr. j-ij twice a day, in pill. They are most 
commonly administered in tincture (5 per cent.) ; dose, gtt. x or 
more three or four times a day till signs of strangury supervene. 

ORDER V.— BLENNORRHETICS. 

Blennorrhetics (from fiXivva, mucus, and pew, I flow) are medi- 
cines which promote the secretion of the mucous membranes. 
They are employed therapeutically in morbid conditions of those 
membranes, with a view to the restoration of healthy action in cases 
of deficient, abnormal or excessive secretion. 

When administered with the object of stimulating .the secretion 
of mucus from the bronchial or laryngeal membrane, this class of 
agents is termed expectorants. They are prescribed in the subacute 
and chronic forms of bronchitis and laryngitis, and in the declining 
stages of the acute forms of those affections and of pneumonia. In 
the early or inflammatory stages of acute bronchitis and laryngitis 
the stimulating expectorants are inadmissible until expectoration 
has been established. 

The blennorrhetics are less employed in gastro-enteric affections 
than in those of other mucous membranes, owing to their tendency 
to produce catharsis. Several of the oleo-resins are, however, used 
with advantage in certain forms of chronic diarrhoea, and the oil of 
turpentine is highly esteemed in the treatment of the diarrhoea of 
typhoid fever. 

The oleo-resinous articles of this group are extensively em- 
ployed in diseases of the urino-genital mucous membranes — gonor- 
rhoea, gleet, leucorrhcea, incontinence of urine and cystitis. 

The following are the articles chiefly resorted to for their 
influence on the mucous membranes : — 

SENEGA. 

Polygala Senega, or Senega Snakeroot ( Nat. Ord. Polygalaceae), 
is a small indigenous plant,- found in all parts of the United States, 
but most abundantly in the South and West. It has a perennial 
branching root, several erect annual stems about a foot in height, 
alternate lanceolate leaves, and small whitish flowers arranged in a 
terminal spike. 

Description. — The root is the official portion. It occurs in 
the shops in twisted pieces, varying in thickness from the size of a 



II EEXXO R RIIETICS— SENEGA. 



399 



pill to that of the little finger, attached to a knotty head, and marked 
with a ridge along their whole length and numerous annular pro- 
tuberances. The cortical portion is hard, resinous, of a yellowish- 
brown color, and contains the active qualities of the root. The 
central ligneous portion is white and inert. The odor of senega is 
peculiar and disagreeable, but faint in the dried root ; the taste is at 
first mucilaginous and sweetish, but afterward becomes acrid and 
very irritating. 

Chemical Constituents. — The virtues of senega are extracted 
by cold and hot water and alcohol. It contains polygalic acid 

FIG. 49. 




POLYGALA SENEGA. 



(senegin), on which its activity chiefly depends ; this is identical with 
saponin, a glucoside found in soapwort and other plants (Huseman*). 

Effects and Uses. — Senega, in small doses, is an active excitant 
of the mucous membranes and secretions generally, and in large 
doses proves emetic and cathartic. 

It is prescribed chiefly as a stimulating expectorant in chronic 
and subacute bronchial affections, and in the latter stages of acute 
bronchitis and pneumonia. As an ingredient in the compound syrup 



*" Die Pflanzenstoffe," 1871, p. 750. 



400 MATERIA MEDICA AND THERAPEUTICS. 

of squill it is much employed in the treatment of croup, but, except 
in some such combination with tartar emetic or other nauseant emetic, 
it is scarcely admissible in the early stages of this disease. Senega 
is thought also to possess emmenagogue properties, and it is highly 
extolled by many practitioners in the treatment of amenorrhcea. It 
has been occasionally used as a diuretic in dropsies, and in emeto- 
cathartic doses has been found useful in acute rheumatism. 

Administration. — Dose, in powder, gr. x-xx ; but the abstract 
is to be preferred ; dose, gr. v-xx. The fluid extracts given in the 
dose of TTlx-xx; and syrup is also used, in the dose of f5J-ij. 

QUILLAIA. 

Quillaia, or Soap-bark, is the bark of the Quillaia Saponaria 
{Nat. Ord. Rosaceae), a tree of South America. 

Description. — The bark is found in the shops in large flat 
pieces, brownish-white, with small patches of brownish cork on the 
outer surface, but otherwise smooth ; without smell, but having a 
very acrid taste ; the powder is sternutatory (Maisch). 

Chemical Constituents. — It contains saponin (C 13 H 30 O 10 , a 
glucoside), which in watery infusion foams like soap, and is identi- 
cal with polygalic acid (senegin). 

Physiological Effects. — The following statement concerning 
saponin is based on the investigations of Lhomme* and Kobert.f 
According to the latter observer, saponin consists of at least four 
organic substances, viz., of pure saponin (Ci 3 H 30 O 10 , inert), lactosin 
(inert), quillaiic acid (C 19 H 30 O 10 ) and sapotoxin — the last two power- 
fully poisonous. The principle experimentally used by Lhomme 
seems to have been a mixture of these substances. Locally, it is a 
protoplasmic poison, and applied to the skin with friction is irritant, 
and if it be continued, will cause suppuration. It abolishes instantly 
the excitability of the striated muscles and nerves when in contact 
with them. Applied directly to the heart it rapidly stops it in dias- 
tole, and antagonizes the effect of digitalis upon it. Kobert ascer- 
tained, his experiments being made with quillaiic acid, that when 
injected into the veins of dogs, and also by the stomach, it expended 
much of its force upon the alimentary canal, which was found to be 
in a highly inflamed condition. Both he and Lhomme found that 

* Pamphlet, "Etude exper. sur Paction physiol. de la saponine." 

j- Arch.f. exper. Pathol, u. Pharmak., 1887 ; also Am. J. Pharm., March, 1889, quoted. 



BLENNORRHE TICS— GA RLIC. 401 

when introduced into the veins in sufficient quantity it paralyzed 
voluntary motion, abolished the reflex excitability of the cord, low- 
ered the blood-pressure, and gradually stopped the heart's beats. 
By ingestion it is much less toxic. Brought in contact with the nose 
and throat it produces violent sneezing and coughing ; applied to 
the conjunctiva it causes pain, swelling and a flow of tears. Lhomme 
observed, without making exact experiments, that the urinary and 
dermal secretions were considerably diminished in frogs, rabbits and 
rats. Schroff noticed an increase of the bronchial mucus. 

Medicinal Uses. — Quillaia is rarely employed medicinally , nor 
are its exact therapeutical uses yet placed on a scientific basis. As 
an expectorant in chronic bronchitis, emphysema and dilatation of the 
bronchi, it has been highly recommended (Kobert*) It is contra- 
indicated where a disposition to hemoptysis is present (A. Mas- 
lovski f), and in inflammatory conditions of the alimentary tract. 
It is chiefly useful from the property it possesses of emulsifying 
oils. 

Administration. — Dose, gr. xv-xxx in infusion t. d. A fluid 
extract mixed with glycerin forms an admirable local application 
to some cases of acne (PifTard). 

ALLIUM— GARLIC. 

Allium sativum (Nat. Ord. Liliaceae) is a small perennial, bulb- 
ous plant, which grows wild in the south of Europe, and is cultivated 
in all parts of the world. 

Description. — The bulb is the portion used. As found in 
the shops, it is somewhat spherical in form, about an inch in diam- 
eter, with the portion of the stem attached, covered with a white, 
membranous envelope, and consists of five or six smaller bulbs, of 
a curved, oblong shape, called cloves of garlic. They have a strong, 
irritating, characteristic odor and a bitter, acrid taste. 

Chemical Constituents. — Water, alcohol and vinegar extract 
their virtues, which depend on an essential oil, which is of a yellow 
color, very volatile and irritating ; it consists of allyl (C 3 H 5 ) oxide 
and sulphide. 

Effects and Uses. — Garlic is a local irritant and rubefacient; 
taken internally, it quickens the circulation and stimulates the secre- 
tions generally. It is a good deal employed as an expectorant 



* Central/. Klin. Med., No 30, 1885. f Russ. Meditz., No. 36, 1886, p. 599. 

26 



402 MATERIA MEDIC A AND THERAPEUTICS. 

in chronic and acute bronchitis, particularly in infantile cases, and 
occasionally as a stomachic in flatulence \ and as a diuretic in dropsies. 
Externally it is used as a rubefacient. 

FIG. 50. 




GARLIC— BULBS. 



Administration. — A clove may be swallowed entire, or cut 
into small pieces. Dose of the fresh bulbs, 3j-ij, in pill; of the juice, 
f3ss, mixed with sugar; of the syrup, f3j, for children. 



SCILLA-SQUILL. 



Squill, already noticed among Diuretics, is one of the most 
powerful and valuable stimulating expectorants in the Materia Medica. 
(For properties, doses, preparations, etc., see index for scilla.) 



TEREBINTHINA— TURPENTINE. 



The term turpentine is applied to liquid or concrete vegetable 
juices, consisting of resin combined with a peculiar essential oil, 
called oil of turpentine. 

Varieties. — Two kinds of turpentine are recognized by the 
U. S. Pharmacopoeia: 1. The common American white turpentine, 
which is procured chiefly from Pinus australis [Nat. Ord. Coniferae), 
a large indigenous evergreen tree of our Southern States, where it 
is called Long-leaved Pine, Yellow Pine, and Pitch Pine ; and in part 



BLENNORRHE TICS- TURPENTINE. 403 

also from Pinus taeda, found in Virginia, and other species of Pinus. 
2. Canada turpentine [Terebinthina canadensis), kept in the shops 
under the name of Canada balsam or balsam of fir \ the product of 
Abies balsamea, the American Silver Fir or Balm of Gilead Tree, 
[Nat. Ord. Coniferae), a handsome tree about forty feet in height, 
inhabiting the northern portions of North America. Many other 
varieties of turpentine are known in commerce, as Bordeaux turpen- 
tine, Venice turpentine, Chian turpentine, etc. 

Preparation. — White turpentine comes from North Carolina 
and other Southern States, and is collected from excavations (called 
technically " boxes "*) made in the trunks of the trees, from March 
to November, into which the turpentine runs in the mild weather. 
It is yellowish-white and somewhat translucent, semi-fluid in summer, 
firm and hard in*winter, but becoming permanently hard by expo- 
sure to the air, and has a peculiar aromatic odor and a warm, pun- 
gent, bitterish taste. Canada turpentine comes from Canada and 
Maine. It is procured by breaking the vesicles which are found 
between the bark and wood of the trees and collecting the liquid 
contents in a bottle. When fresh it has the consistence of honey, 
but gradually solidifies by age. It is yellow, transparent, tenacious, 
of a peculiar pleasant, terebinthinate odor and a slightly bitter, 
acrid taste. 

Chemical Constituents. — The turpentines yield, by distillation, 
a volatile oil known as oil of turpentine, and leave a residue consist- 
ing exclusively of resin. Both the oil and resin are official. The 
turpentines are inflammable, nearly insoluble in water, but almost 
wholly soluble in alcohol and ether. 

Physiological Effects. — The local operation of the terebin- 
thinates is irritant. When applied to the skin they produce a rube- 
facient effect, and when swallowed in large doses, promote the peris- 
taltic motion of the intestines. Taken internally, in small doses, 
they are absorbed, and prove excitant to the vascular system and the 
secretions generally, especially the mucous membranes ; they com- 
municate an odor of violets to the urine. In large doses they cause 
pain in the loins, strangury and bloody urine. The activity of the 
terebinthinates depends on their volatile oil. 

Medicinal Uses. — Turpentine is employed chiefly in diseases 
of the various mucous membranes, as gonorrhoea, gleet, leucorrhoea, 

*" Our Slave States," 1856, p. 339, F. L. Olmsted. 



404 MATERIA MEDIC A AND THERAPEUTICS. 

chronic bronchitis, and chronic mucous diarrlioea. It is also used in 
iritis ; and, in cathartic doses, in cases of thread-and tape-worms. 

Administration. — Dose, as a blennorrhetic •, gr. xx-5j, in pill, 
emidsion, or electuary ; as an anthelmintic or cathartic, 5ss-j in emul- 
sion. The white turpentine is generally used in this country. 

Chian Turpentine is derived from Pistacia Terebinthus [Nat. 
Ord. Anacardiaceae), and is collected chiefly in the island of Scio, 
during the summer months, the juice flowing spontaneously from 
incisions made in the bark. It is " greenish-yellow or brownish, 
hardens to a transparent mass, and has a fennel-like terebinthinate 
odor, and a mild, bitterish taste" (Maisch). It is very expensive, 
and but little of it comes to this country. It has been extolled in 
the treatment of uterine cancer, but sound observers* now agree 
that it is utterly valueless as a curative agent. * Dose, gr. v, in- 
creased to gr. xxv, in emulsion. 

Oleum Terebinthinae [Oil of Turpentine') (C 10 H 16 ) commonly 
called spirit of turpentine, is the active principle of turpentine, ob- 
tained by distillation. It is a limpid, colorless, volatile and inflam- 
mable liquid, of a strong, penetrating, peculiar odor and a hot, pun- 
gent, bitterish taste ; very slightly soluble in water, less soluble in 
alcohol than the volatile oils generally, and wholly soluble in ether ; 
exposed to the air it absorbs oxygen, with the formation of resin. 
Its effects and medicinal uses are the same as those of turpentine, 
for which it is usually substituted in practice. 

Aids. — Its effects are enhanced by the alcoholic and diffusible 
stimuli. 

Contraindications. — In cardiac hypertrophy, atheroma of the 
vessels, and acute renal inflammation. 

Physiological Effects. — Locally, it acts as a rubefacient. 
When swallowed in large doses, as f oj-ij, it commonly passes off by 
the bowels; taken in small doses, it is absorbed and, according to 
the investigations of Hare,f it increases the number of the cardiac 
beats, due to a direct action on the heart ; large doses decidedly 
slow the pulse by stimulation of the vagus inhibitory centre. Its 
influence, either in large or small amounts, is indifferent upon the 
vaso-motor centre, though this statement, is not in accord with that 
of Kobert.J Small doses increase reflex action, while large de- 

* Lancet, Dec. 4th, 1880. Mr. Henry Morris. f Med > News, Phila., 1887, II, p. 593. 
% Arch, fur Anat. u. Physiol., 1886— quoted. 



HLENNORRHETICS— TURPENTINE. 405 

crease it; the first being due to stimulation, and the latter to depres- 
sion of the cord and afferent nerves. Toxic amounts destroy life by 
causing cardiac failure. Respiration is at first increased, but after- 
ward diminished as to frequency. Secretion : when given in mod- 
erate doses it stimulates the kidneys, augmenting the urinary flow. 
In large amounts (foj-ij), the urine is diminished, often bloody and 
sometimes suppressed. Toxic quantities provoke constant efforts 
at micturition, strangury and often priapism. Gastro-intestinal 
tract: in large quantities it causes vomiting and purging, with ab- 
dominal pain and a sense of heat. Elimination : by the broncho- 
pulmonary mucous membrane and kidneys (chiefly). 

Toxicology and Antidotes. — The lethal dose is not deter- 
mined, but poisonous effects from the oil of turpentine are rare, as 
it generally passes off by the bowels ; it may, however, produce 
severe vomiting and purging, bloody or suppressed urine, intense 
irritation of the urino-genital organs, unconsciousness, with dilated 
pupils, and even death. An infant* swallowed f 5j£, but recovered 
after convulsions. Its toxic effects maybe antagonized by emptying 
the stomach and the administration of anodynes and demulcents. 
Physiologically it is antagonized by the cardiac depressants. 

Medicinal Uses. — In large doses it is employed as an anthel- 
mintic and cathartic, and is much used as a clyster for the relief of 
tympanites. In small doses it is much prescribed in chronic dis- 
charges and hemorrhages from the various mucous membranes ; in 
the latter stages of typhoid fever, where the abdomen is tympanitic 
and the tongue dry; as a combined stimulant and blennorrhetic; as 
a stimulant in typhus fever\ and purpura; as a diaphoretic in rheu- 
matism, and in nephritic disorders as pyelonephritis. As a rubefacient, 
it is a valuable counter-irritant in numerous diseases, as to the joints 
in chronic rheumatism, and should usually be applied with gentle fric- 
tion. Turpentine-stupes are highly efficacious in bronchial catarrhal 
affections. 

Administration. — Dose, gtt. v-xxx, repeated, as a blennor- 
rlietic stimulant ; f.5ss-j, as a cathartic enema or anthelmintic against 
round and thread-worms , J in emulsion or capsule. Linimentum 
terebinthince (oil of turpentine, 35 parts, melted with resin-cerate, 



* London Med. Times, 1851, p. 380. 

t Am.Journ. Med. Set., 1866, p. 48. DaCosta. 

J Journal de_ Therap., 1876, p. 871. 



406 MATERIA MEDICA AND THERAPEUTICS. 

65 parts), is used as a stimulative application in various affections, 
as, chilblain^ lumbago and myalgia, 

Pix Liquida (Tar) is an impure turpentine, procured, by burn- 
ing, from the wood of Pinus palustris and other species of Pinus. 
It is a brownish-black, viscid, semi-liquid substance, of a peculiar 
empyreumatic odor and a bitterish, resinous, somewhat acid taste ; 
soluble in alcohol, ether and the volatile and fixed oils. It consists 
of resin united with acetic acid, oil of turpentine and various volatile 
empyreumatic products. By distillation it yields pyroligneous acid 
and oil of tar, the residuum being pitch. 

The oil of tar (oleum picis liquidce) contains, besides oil of tur- 
pentine, creasote (see Antiseptics) and other principles'. Its effects 
are similar to those of tar, and it is much used in the form of ointment 
in the treatment of squamous skin diseases. 

Toxicology. — A case is reported, of non-fatal poisoning,* by oil 
of tar of a man who, having swallowed about one gill, was seized 
after seven hours with vomiting, excessive abdominal and inguinal 
pain and exhaustion, the urine being high-colored and having the 
odor of the drug. 

Effects and Uses. — Tar resembles the turpentines in its 
effects, and is employed in chronic catarrhal affections and other 
diseases of the mucous membranes. Its vapor has been inhaled 
in bronchitis, acute and chronic ; and externally it is an excellent 
application in tinea capitis, psoriasis and eczema. The therapeutical 
application of the tarry preparations in diseases of the skin has 
been well described by Bulkleyf as follows : they are contra- 
indicated in cases of decided pain, heat or swelling, and indicated 
where it is desirable to improve the nutrition, check the itching, 
secretion and cell-deposit of a part. Their disadvantages are odor, 
color and stickiness : the former can be partly disguised by oil of 
lavender. Equal parts of pix liquida and unguentum sulphuris is 
an excellent application to scaly eczema and palmar psoriasis, and it 
should be applied with friction. In liquid form the following has 
been used with advantage to allay the intense itching of eczema 
after the exudation has ceased, and also in lichen. 1^ Picis liquidae, 
f3ij ; potassae causticae 5j ; aquae f5v. M. Solve (may require dilu- 
tion) ; in chronic cases it should be rubbed in of full strength. The 



* Lancet, 1832-3, p. 598. 

f Arch, of Scientific and Practical Medicine, 1873, PP- I2 3 x 7 2 - 



BLENNORRHETICS- COPAIBA. 407 

infusum picis liquidae (tar Oj aq. Oiv) is another serviceable liquid 
preparation in eczema and prickly heat, being curative as well as 
antipruritic. In parasitic diseases as ringworm and favus, the fol- 
lowing unirritating combination is useful : 1^ Iodinii, 5ij ; olei picis 
liquidae, f§j. M. Solve. Mix carefully and rub in freely. 

Administration. — Dose, 5ss-j several times a day, in pill or 
electuary. The syrup contains six per cent, of tar, and is a good 
preparation. The ointment (imguentnm picis liquidce) is made by 
mixing equal parts of tar and melted suet. 

Resina (Resin), commonly called rosin, is the residue after the 
distillation of the oil from turpentine. It is a yellowish-brown, 
semi-transparent, solid, brittle substance, with a slight terebinthinate 
odor and taste — insoluble in water, soluble in ether, alcohol 
and the essential oils, readily uniting by fusion with wax and the 
fixed oils, and forming soluble soaps with the alkalies. When agi- 
tated with water, in a state of fusion it becomes opaque and white. 
It is not used internally, but is extensively employed in the forma- 
tion of plasters and ointments, to which it communicates great 
adhesiveness and slightly stimulant properties. 

Ceratum resince (resin-cerate), formerly called basilicon ointment, 
is made by melting resin (35 parts), lard (50 parts) and yellow wax 
(15 parts) together; it is an excellent mild stimulant application to 
burns, blistered surfaces, etc. Compound resin- cerate may be made 
by melting 5xij of resin, suet and yellow wax, each, with Syj of tur- 
pentine and f§vij of flaxseed oil — a good stimulant cerate, very pop- 
ular under the name of Deshler's Salve — a favorite application to 
fissure of the nipples. Emplastrum resince (resin-plaster), made by 
melting 14 parts of resin with 80 parts of lead-plaster and 6 parts of 
yellow wax, is the well-known adhesive plaster, which is used to 
retain the edges of zvounds in contact, to produce extension in the 
treatment of fractures, to protect abraded surfaces, and to promote 
absorption as in hydrocele and orchitis. It must be heated before 
application. 

An adhesive rubber plaster is now made that offers the advan- 
tage of sticking where applied without the aid of heat or other agent. 

COPAIBA. 

Copaiba is an oleo-resin obtained from several species of 
Copaifera (Nat. Ord. Leguminosae), large trees peculiar to South 
America. C. Langsdorffii, a native of Brazil, is now recognized as 



408 MATERIA MEDICA AND THERAPEUTICS. 

the principal source of copaiba, and most of the copaiba of com- 
merce is derived* from the ports of Para and Maranham, in Brazil; 
Central America also yields copaiba. 

Preparation. — The juice is obtained from incisions in the stems 
of the trees; as it at first exudes it is clear, colorless and very thin, 
but soon acquires a thicker consistence and a yellowish hue. As 
found in the shops it is a clear, transparent liquid, of the consist- 
ence of olive-oil, of a pale-yellow color, a peculiar agreeable smell 
and a pungent, nauseous, acrid taste. By exposure to the air it 
acquires a deeper color and denser consistency. It is often adul- 
terated. 

Chemical Constituents. — Copaiba is insoluble in water, but 
soluble in alcohol, ether, and the volatile and fixed oils; with alkalies 
and alkaline earths it forms a soap. It is chemically an oleo-resin 
(40 to 60 per cent, of volatile oil, but the proportion of oil to resin 
varies considerablyf), with a minute portion of acetic acid. The 
volatile oil is official, as is also the resin, which possesses acid pro- 
perties, and is sometimes called copaiyic acid. By exposure to the 
air copaiba gradually becomes darker and thicker, and finally hard 
and brittle, owing to the volatilization and oxidation of its oil. 
A pulverizable residue should remain when the volatile oil is 
driven off by heat. Copaiba was formerly called a balsam, but this 
title is incorrect, as it contains no benzoic or cinnamic acid. 

Contraindications. — Gastro-intestinal irritation and renal in- 
flammation. 

Physiological Effects. — The effects of copaiba are analogous 
to those of the terebinthinates. In large doses it proves cathartic and 
occasionally emetic, and in small doses it is absorbed, communi- 
cating its peculiar odor to the secretions and exhalations, and stimu- 
lating the secretions from the mucous membranes and kidneys; it 
is also a gentle excitant to the circulatory system. The urine of 
persons who have taken copaiba for some time yields a precipitate 
with nitric acid, like albuminous urine, due to the action of the 
acid on the resin. The resinous precipitate, however, is soluble in 
alcohol, which does not dissolve coagulated albumen. Elimination 
takes place slowly. Occasionally copaiba causes symptoms of 
strangury when given in large doses. It sometimes produces an 
eruption of the skin, and some persons are unable to take it in any 



*" Pharmacograph, ,> 2d ed., p. 232. f Am Journ. of Syphilography, III, p. 293. 



BLENNORRHE TICS— CO PA IB A. 409 

dose, on account of the gastro-intestinal irritation which it occasions. 
When its administration is top long continued, or when excessive 
doses are given, it may undoubtedly cause serious damage to the 
structure of the kidney. 

Medicinal Uses. — Copaiba is employed in diseases of the 
mucous membranes, particularly those of a chronic character, as 
chronic bronchitis, gonorrhoea, gleet, and irritation of the bladder, and, 
like turpentine, occasionally in iritis. 

As a remedy in gonorrhoea it has long enjoyed great popularity, 
and is given in some cases with advantage even in the early stages. 
Though often of signal service in the treatment of gonorrhoea, it 
frequently fails to ameliorate the disease, for, in 15 cases in which 
copaiba was the basis of treatment together with injections, recorded 
by Milton,* the average duration of each was 88 days — not brilliant 
evidence of the utility of the remedy. The good results obtainable 
with this drug are often missed through inattention to concomitant 
matters. During the acute stage the inflammatory symptoms, if 
severe, must be combated by rest, and the local application of lead 
or ice-water; the parts should be kept clean; the urine neutralized; 
a non-stimulant diet enforced by abstention from meats and alco- 
holics; erections suppressed by avoiding lascivious thoughts; and 
chordee restrained with a large dose of potassium bromide 
(5^-j), at 9-10 p. m., combined with a motor- depressant, as tinc- 
ture of gelsemium (gtt. x), both to be repeated at 3-4 a. m., the 
time when chordee is most likely to set in. When the acute symp- 
toms have begun to subside under this plan of treatment the time 
for the exhibition of copaiba and urethral medication has arrived. 
Urethral injections of copaiba have been tried, but have not yielded 
good results; it therefore appears to be necessary, in order to ob- 
tain its curative effects, that the drug should be modified in the sys- 
tem before its passage over the urethral tract. In gonorrhceal 
vulvitis and vaginitis it is comparatively useless. Copaiba is some- 
times advantageously combined or alternated with cubeb. When it 
nauseates, it should be suspended, or the dose reduced. It is best 
administered on an empty stomach. It is often advantageously 
combined with solution of potassa, which diminishes the acidity of, 
and hence the irritation produced by, the urine. 

Administration. — Dose, gtt. xx to f5j t. d., in emulsion, with 

*'' Gonorrhoea," etc., 1877, p. 75. 



410 MATERIA MEDIC A AND THERAPEUTICS. 

some aromatic water, * or in pilular mass (mass a copaibce), made by 
mixing copaiba 94 parts with magnesia 6 parts, or in capsules of 
gelatin, which is the preferable mode of administration. These can 
be obtained in the shops, each containing Tftv or x. It is also ad- 
ministered as a clyster, in emulsion. 

Oleum Copaibae (Oil of Copaiba) (Ci 5 H M ), obtained by distillation 
from copaiba, is usually colorless, with the odor and taste of copaiba, 
and produces the same effects on the system. (U. S. Dispensatory, 
15th Ed.) Dose, gtt. x-xv, in emulsion or dropped on sugar. 

CUBEBA— CUBEB. 

Cubeb is the unripe fruit of Cubeba officinalis (Nat. Ord. 
Piperaceae), a climbing perennial plant of Java and other parts of the 
East Indies. 

Description. — The berries are gathered for use when unripe, 
and are dried. They are about the size of a small pea, of a blackish 
or grayish-brown color, a reticulated surface, and furnished with a 
stalk two or three lines long. The shell is hard, and contains a 

Fig. 51. 

# # A 

CUBEB-BERRIES. 

blackish seed, which is white and oily within. The odor of cubeb 
is aromatic ; the taste warm, acrid, and camphoraceous. The ber- 
ries deteriorate by age, most rapidly in powder, owing to the escape 
of their volatile oil. 

Chemical Constituents. — Their most interesting constituents 
are a volatile oil (which is official) (C 30 H 48 ), a principle called 
cubebin, and resinous matter ; the resinous matter consists of both a 
hard and a soft resin, the former insoluble in ether, the latter soluble 
in ether, of acid reaction, and termed cubebic acid. The oil is car- 
minative and stimulant, and the blennorrhetic and diuretic properties 
of cubeb reside chiefly in the resin ; cubebin is inert. 



* Chapman* s Copaiba Mixture, is, copaiba and spirit of nitrous ether, each half a fluid- 
ounce ; powdered gum-arabic and sugar, each a drachm ; compound spirit of lavender, 2 
tiuidrachms ; tincture of opium, a fluidrachm ; distilled water, 4 fluidounces ; dose, a table- 
spoonful three times a day. Often very efficient in the treatment of gonorrhoea. 



BLENNORRHETICS—OIL OF SANTAL. 411 

Effects and Uses. — In large doses cubeb, like the other oleo- 
resins, excites more or less gastro-enteric disturbance. In small 
doses it produces a stomachic effect like that of black pepper; after 
its absorption it acts as a gentle excitant to the vascular system, 
with a very decided stimulant action on the mucous surfaces, par- 
ticularly those of the urino-genital apparatus ; it also frequently 
proves diuretic. It is eliminated chiefly by the urine, increasing the 
excretion of uric acid, and under its use the urine yields a precipi- 
tate with nitric acid. An eruption, like urticaria, sometimes follows 
the administration of both copaiba and cubeb. 

It is used chiefly in the treatment of gonorrhoea, and should be 
given under the same conditions as copaiba (q. v.). The late Prof. 
Joseph Pancoast prescribed it as follows : ^ Pulveris aluminis, 5j ; 
pulveris cubebae, §iv ; pulveris cinnamomi, 5ss. M. et Sig. — Table- 
spoon in half a glass of water three times a day. When thus given, 
it quickly allays the scalding pain which accompanies urination. 

Powdered cubeb-berries have been used as a smoke in nasal 
catarrh; they also enter into the composition of voice-lozenges 
that are useful in chronic pharyngitis. 

Administration.— Dose of the powder, 5j-iij t. d., in gonor- 
rhoea ; in chronic mucoifs disorders smaller doses are given. The 
oil is often employed, but it does not possess the full virtues of 
cubeb — dose, gtt. x-xij,.to be repeated and gradually increased; it 
may be taken in emulsion, or dropped on sugar, or made into gela- 
tinous capsules with oil of copaiba. The oleo-resin contains both 
the volatile oil and resin, with a portion of cubebin, and is an ex- 
cellent preparation — dose, TTlv-xxx, suspended in water; of the 
tincture, the dose is f5j-ij t. d. ; of the fluid extract, the dose is 
f5ss-j. Troches of cubeb are made with the oleo-resin, oil of sassa- 
fras, extract of glycyrrhiza, and acacia, mixed with syrup of tolu. 
Each troche contains gr. y 2 of oleo-resin. 

OLEUM SANTALI— OIL OF SANTAL. 

The oil of Santal or of Sandal Wood is a volatile oil dis- 
tilled from the wood of Santalum album {Nat. Ord. Santalace^e), a 
small tree found in tropical Asia. 

The oil is pale yellowish and thick, readily soluble in alcohol 
when fresh, having an aromatic odor resembling the smell of the 
wood, and a pungent, spicy taste. 

Effects and Uses. — It has been highly recommended in the 



412 MATERIA MEDICA AND THERAPEUTICS. 

treatment of gonorrhoea, though the experience as to its efficacy in 
this disease is contradictory. It was introduced by Henderson* 
who states that he always obtained with it marked suppression of 
the discharge, and by whom it is regarded as quite equal to copaiba. 
Beachf reports his experience in ioo cases as follows: average dura- 
tion of the uncomplicated cases six weeks, shortest case six days, 
longest about 42 days. He gave gtt. xx or more t. d. In this 
disease its effects seem to be similar to those of copaiba, but it is not 
so apt to disagree with the stomach. In a series of 12 cases of go- 
norrhoea in which it was administered by the editor in doses of gtt. 
x, t. d., the results were not uniform. In a few cases it appeared to 
cut short the disease in about four days ; in others it disagreed with 
the patient and was abandoned, and in some cases no benefit was 
obtained. Milton): records 22 cases without a single cure. It occa- 
sionally (in about four per cent, of cases) produces vertigo, when the 
dose should be lessened or the medicine discontinued. It is very 
expensive, and is often adulterated with olive- oil. 

Administration. — It may be giyen in doses of Hlv-xx, t. d, 
on a lump of sugar, in mucilage, in alcohol and cinnamon-water, or 
it can be obtained in gelatin-capsules, TTtv each, in the shops. An 
objection to its use is the odor of the drug, which its ingestion soon 
imparts to the breath. It should be administered at the onset of 
the disease. 

MATICO. 

This name is given to the leaves of Artanthe elongata {Nat. 
Ord. Piperaceae), a shrub of Peru. They are from two to six inches 
long by about an inch in breadth, oval-lanceolate and acuminate in 
shape, crenate, strongly veined or reticulated, bright-green on the 
upper surface, paler beneath, of a pleasant, aromatic odor and a 
strong, spicy, slightly astringent taste. The stalks and spikes 
of the plant are generally mixed with the leaves, more or less com- 
pressed into a lump of a greenish color. Matico contains resin, volatile 
oil, artanthic acid, tannin, etc. 

Effects and Uses. — Matico is a pleasant aromatic tonic, with 
a special determination to the mucous membranes. It is used as an 
alterative stimulant in the entire circle of diseased mucous mem- 



* Glasgow Med. Journ., Vol. XIII, p. 70 ; and Med. Times and Gas., 1861, p. 571. 
f Boston Med. and Surg. Journ., 1868 -9, p. 213. 
t " Gonorrhoea, etc.," 1887, p. 87. 



BLENNORRHETICS—BUCHb. 413 

branes, especially those of the urinary passages. It is also occa- 
sionally prescribed internally as a hemostatic, and locally as a styptic. 
Administration. — Dose, of the powder, 5ss-j ; of the fluid 
extract f oss-j ; of the tincture, f5j-ij. 

PAREIRA. 

Pareira or Pareira Brava is the root of Chondodendron tom- 
entosum (Nat. Ord. Menispermaceae), a native of Brazil. It comes 
to us, in large, wrinkled, twisted or forked cylindrical pieces, of 
variable thickness and length, covered with a thin, grayish-brown 
bark. The interior is ligneous, yellowish, porous, inodorous, and 
of a sweetish, nauseous, bitter taste. The stem is sometimes found 
in the shops mixed with the root ; it is inert. 

Chemical Constituents. — It imparts its virtues to water, and 
contains a bitter alkaloid, termed cissampeline (C 18 H 21 N0 3 ) 5 (identi- 
cal with pelosine, buxine, and beberine, Fluckiger,*) resin, fecula, etc. 

Effects and Uses. — Pareira is an excellent remedy in chronic 
diseases of the urinary passages, particularly chronic cystitis or irri- 
tation of the bladder, with morbid secretion. It is thought to be 
also tonic, aperient, and diuretic. 

Administration. — Dose, in substance, 5ss-j. The fluid extract 
is much used — dose, f 3ss.f 

BUCHU. 

This is the name given to the leaves of Barosma betulina and 
other species of Barosma (Nat. Ord. Rutaceae), shrubby plants, 
growing at the Cape of Good Hope. 

Description. — As found in the shops, buchu leaves are from 
three-quarters of an inch to an inch and a half long, from three to 
five lines broad, elliptical, lanceolace-ovate or obovate, sometimes 
pointed, sometimes blunt, notched, and glandular at the edges, and 
of a green color, paler on the under surface. Three varieties are 
known, viz. : short or round buchu (derived from B. betulina), 
medium-sized (from B. crenulata), and long buchu (from B. serrati- 
folia). They have a strong aromatic odor and a bitterish taste, like 
that of mint. 



*" Pharmacographia," 2d edition, pp. 28 and 109. 

f A good prescription in irritable bladder 'is fluid extract of pareira brava, f ^j ; compound 
spirit of juniper, f J ij ; benzoic acid, £j ; sulphate of morphia, gr. j ; dose, a teaspoonful 
three times a day. 



414 MATERIA MEDICA AND THERAPEUTICS. 

Chemical Constituents. — Water and alcohol extract their 
virtues, which depend on a volotile oil (which yields barosma cam- 
phor*) and bitter-extractive. 

Effects and Uses. — Buchu is a gentle stimulant to the secre- 
tiojis generally, particularly to the kidneys and urinary mucous 
membranes ; it may be made to act also as a diaphoretic. It is 
chiefly employed in urethritis and chronic cystitis, chronic nephritic 
complaints, and incontinence of urine. 

Administration. — Dose, of the powder, gr. xx-xxx ; of the 
fluid extract, f5ss-j. 

uva ursi. 

Arctostaphylos Uva ursi, or Bearberry {Nat. Ord. Ericaceae), 
is a small trailing evergreen shrub, with coriaceous, obovate leaves 

Fig. 52. 




UVA URSI. 

(somewhat like the box-leaves and red whortleberry leaves), 
about half an inch in length, pale rose-colored flowers appearing 
from June to September, and small red berries which ripen during 
the winter. It is found in the northern parts of Asia, Europe and 
America. The leaves are the only part used. When dried they 
have a faint hay-like odor and a bitterish, astringent taste. 

* " Pharmacographia," 2d edition, pp. 28 and 109. 



BLENNORRHE TICS— CHIMAPHILA . 415 

Chemical Constituents. — They yield their virtues to water 
and alcohol, and contain tannic and gallic acids, ursonc, a crystal liz- 
able glucoside termed arbutin (C 24 H 32 14 ), a bitter substance termed 
tricolin (C 34 H 5tJ 21 ), extractive \ resin, gum, etc. 

Effects and Uses. — Uva ursi is astringent, tonic \ and diuretic 
and exercises a beneficent control over discharges from mucous 
surfaces ; hence its employment in chronic cystitis, and chronic bron- 
chitis with profuse discharge. It is applicable also to the ordinary 
uses of the vegetable astringents. 

Administration. — Dose, of the powder, gr. x-5j. The dose 
of the jfluid extract is f3ss-j. 

CHIMAPHILA. 

Chimaphila umbellata, Pipsissewa, Wintergreen, or Ground- 
Holly {Nat. Ord. Ericaceae), is a small indigenous evergreen plant, 
common to the northern parts of Europe, Asia and America, and 
found abundantly in woody situations in all parts of the United 
States. It has an erect stem three to ten inches high, lanceolate, 
somewhat wedge-shaped, serrated, dark-green leaves arranged in 
irregular whorls, and beautiful five-petaled flowers, of a white color 
tinged with red and a very agreeable perfume, which appear in June. 
The leaves are the official portion. In the fresh state they have a 
fragrant smell when bruised, which they lose after drying. Their 
taste is bitterish and astringent, but somewhat aromatic. 

Chimaphila maculata, or Spotted Pipsissewa, possesses proper- 
ties analogous to those of C. umbellata, from which it differs prin- 
cipally in the character of its leaves. They are of a deep olive-green 
color, mixed with greenish-white ; and the flowers are of a pure 
white, and appear in July. 

Chemical Constituents. — They contain arbntin (not ursone), 
tannic acid, chimaphilin (crystalline),, an oil* identical with oil of 
birch, methyl salicylate, an hydro-carbon (C^H^), and small quan- 
tities of benzoic acid. 

Effects and Uses. — Pipsissewa is tonic, astringent, diuretic 
and blennorrhetic, resembling buchu and uva ursi in its effects, but 
being a more active diuretic, and is used in the disorders of the urinary 
organs to which they are applicable, and, from its diuretic proper- 
ties in dropsy. According to Abet,f who made a careful analysis 

* Am. Journ. of Pharmacy, Aug. 1889. Trimble and Schroettes. 
f Bull. Gen. de Therap., 1889, to ii, p. 64. 



416 



MATERIA MEDIC A AND THERAPEUTICS. 



of the leaves, the diuretic principle resides in them, which he desig- 
nates as a " soft alcoholic extract; " and with this he got good results 
in ten cases of cardiac dropsy attended by dyspncea. 

Fig. 53. 




CHIMAPHILA UMBELLATA. 



Administration. — The dose of the fluid extract is f5ss-j. 



MYRRHA— MYRRH. 



Myrrh is a gum-resin obtained from Balsamodendron Myrrha 
[Nat. Ord. Burseraceae), a small shrubby tree of Arabia Felix and 
Africa. 

Preparation and Description. — Most of the myrrh of com- 



BLENNORRHETICS BENZOIN. 417 

merce is derived from the eastern coast of Africa, in the Somali* 
district, where it is collected by the Arabs. The juice exudes spon- 
taneously and concretes upon the bark (like cherry-tree gum). It 
is imported from Bombay, and occurs in small, semi-transparent, 
reddish-yellow fragments or tears — sometimes agglutinated to- 
gether in large masses — of irregular shape and size, with an agree- 
able, peculiar odor and a bitter, aromatic taste. It is brittle and 
pulverizable, has a resinous fracture, and makes a light-yellowish 
powder. Inferior kinds of myrrh are darker and less translucent 
and odorous. 

Chemical Constituents. — Myrrh is &gum resin (of resin 25-40 
per cent), containing also a little volatile oil (^ per cent.) and a 
bitter-principle (glucoside ?). It forms with water an emulsion, and 
is soluble in alcohol and ether. 

Effects and Uses. — Myrrh is stimulant, expectorant and em- 
menagogue. It is prescribed in chronic catarrhal and asthmatic af- 
fections in which a combined corroborant and expectorant effect is 
desirable. Chalybeates and aloes are frequently united with it in 
uterine affections. Locally, it is a good application to the spongy 
gums of gingivitis and aphthous sore, mouth. In fetid breath the fol- 
lowing forms a good cleansing mouth-wash : Ty Tincturae myrrhae, 
f Sj ; acidi carbolici liquidi, ttlx. M. Sig. — Rinse the mouth with a 
teaspoonful in y 2 tumbler of water. 

Administration. — Dose, gr. x-xxx in powder or pill, or sus- 
pended in water, as in mistura ferri composita (see p. 168). The 
tincture is employed chiefly externally; dose, internally, f5ss-j. 
Pills of aloes and myrrh, compound galbanum pills and compound 
iron-pills are official emmenagogue preparations of myrrh. 

benzoinum— benzoin. 

Benzoin is a balsamic resin obtained from Styrax Benzoin, 
or Benjamin tree {Nat. Ord. Styraceae), a tall tree of northern 
Sumatra,! and Siam.. 

Preparation. — It is obtained by incisions in the bark from 
which it readily exudes, afterward hardening by exposure to the sun 
and air, when it is pared off with a knife. Two kinds are known, 
the more valuable consisting chiefly of whitish tears, united by a 

* Pharm. Journal, XII, p. 226. Jas. Vaugh. 
f " History of Sumatra," p. 123, 1783. Marsden. 
27 



418 MATERIA MEDICA AND THERAPEUTICS. 

reddish-brown connecting medium, and called benzbe amygdaloides, 
the other of brown or blackish lumps, without tears, known as 
benzoe in sortis (benzoin in sorts). Benzoin has a fragrant odor, a 
feeble, slightly aromatic taste, is soluble in alcohol and ether, and 
is precipitated from its alcoholic solution by water. 

Chemical Constituents. — Its chief constituents are resin and 
benzoic acid (C 7 H 6 2 ), which places it among the balsams ; it con- 
tains volatile oil and occasionally cinnamic acid (C 9 H 8 2 ). Samples 
containing the latter should be rejected (U. S. P.). 

Effects and Uses. — This drug owes its virtues chiefly to ben- 
zoic acid, which will be considered under the head of Antiseptics. 
Benzoin is a topical irritant, and after absorption, stimulates the 
broncho-pulmonary and other mucous membranes. It resembles 
myrrh in its effects, but is rather more acrid and stimulating. It is 
adapted to chronic bronchial affections, but is seldom employed 
alone. As a fumigation in chronic laryngitis it has been recom- 
mended by Trousseau and Pidoux. It is also used in chronic cyst- 
itis when the urine is alkaline and deposits phosphates, but the ben- 
zoates, especially ammonium benzoate, are more adapted to these 
cases. 

Administration. — Dose, gr. x-xxx. The tincture of benzoin 
and the compound tincture (containing benzoin, purified aloes, storax 
and balsam of tolu dissolved in alcohol, and known as Friar's Balsam) 
are used as stimulating expectorants and in bowel complaints ; dose, 
f5ss-ij. As benzoin has the property of obviating the rancidity 
to which lard is liable, this is a very useful vehicle for medicated 
ointments. Adeps benzoinatus consists of benzoin, 2 parts, and lard 
ioo parts. Benzoin is much used in the form of fumigating 
pastiles. 

STYRAX— STORAX. 

Storax is a balsam prepared from the bark of Liquidambar 
orientalis {Nat. Ord. Hamamelacese), a native of Asia Minor. 

Preparation. — It is obtained by steaming the bruised bark and 
then expressing it, and occurs as a soft, viscid, brownish mass of 
the consistence of honey, yet more or less tenacious, of a fragrant 
odor and a warm taste. 

Chemical Constituents. — It contains storesin, an amorphous 
substance — the most abundant constituent — an oil termed styrol 
(C 8 H 8 ) (not always present), resin, cinnamic acid (and is therefore a 
balsam), and an essential oil. Alcohol and ether are its proper sol- 
vents. It is almost always more or less adulterated. 



BLENNORRHETICS— BALSAM OF TOLL. 419 

Effects and Uses. — It is used as a stimulant expectorant 
chiefly in the compound tincture of benzoin ; dose, gr. x-xx. 

BALSAMUM PERUVIANUM— BALSAM OF PERU. 

Balsam of Peru is a balsam obtained from Myroxylon Pereirae 
{Nat. Ord. Leguminosae), a tree of Central America (Salvador). 

Preparation — It is 'obtained from incisions in the bark, and is 
collected on rags inserted in the openings, which are afterward 
boiled in water, when the balsam settles at the bottom, and the water 
is poured off. A white balsam, obtained from the fruit of this tree 
by expression, and a tincture of the fruit in rum, are also known in 
Central America. Balsam of Peru has the consistence of honey, a 
dark, reddish-brown color, a pleasant smell, a warm, bitterish, acrid 
taste, and is soluble in alcohol and partially so in boiling water. It 
is heavier than water. 

Chemical Constituents. — Its constituents are cinnamein (ben- 
zylic cinnamate, a colorless aromatic oil), resin, benzalcohol, benzylic 
benzoate, stillbene, and cinnamic and benzoic acids. 

Effects and Uses. — It is a stimulating blennorrhetic and tonic-, 
employed occasionally in chronic bronchitis, asthma, gonorrhoea, and 
leucorrhoea, but not much used in this country. Externally it is ap- 
plied to indolent ulcers, as a surgical dressing. 

Administration.— Dose, fjss in emulsion. 

BALSAMUM TOLUTANUM— BALSAM OF TOLU. 

Balsam of Tolu is a balsam obtained from Myroxylon toluifera 
{Nat. Ord. Leguminosae), a tree of the neighborhood of Carthagena. 

Preparation. — It is procured from incisions in the trunk of 
the tree, and concretes in the vessels in which it is received. It has 
a soft tenacious consistence, varying with the temperature, and by 
age becomes hard and resin-like. It is shining, translucent, of a 
reddish-brown color, a fragrant odor and a warm, sweetish, pungent 
taste, inflammable, entirely soluble in alcohol and the essential oils, 
and, like the other balsams, yields its acid to boiling water. 

Chemical Constituents. — Its ingredients are resins, benzylic 
benzoate (a colorless aromatic oil), benzylic cinnamate, tolene, and 
cinnamic and benzoic acids. 

Effects and Uses. — It is a stimulant blennorrhetic and tonic, 
useful in chronic catarrhal affections, and, from its agreeable flavor, 
much employed as an ingredient of cough-mixtures. The vapor of 



420 MATERIA MEDIC A AND THERAPEUTICS. 

an ethereal solution of this balsam is inhaled with advantage for 
the relief of cough. 

Administration. — Dose, gr. x-xxx, in emulsion, frequently re- 
peated. The tincture {tinctura tolutand) is added to cough-mixtures; 
dose, f 5j-ij. The syrup (syrupus tolutanus) is used as a vehicle for 
other medicines. Balsam of tolu is an ingredient of the compound 
tincture of benzoin. 

The following gum-resins, previously notjced among antispas- 
modics, are employed as expectorants : — 

Asafgetida (Asafetida). (See p. 121.) 

Ammoniacum (Ammoniac). See p. 123.) 

Galbanum. (See p. 123.) 

ORDER VI.— EMMENAGOGUES. 

Emmenagogues (from ijujurjvca, the catamenia, and aymyo^, ex- 
citing) are medicines which promote the menstrual discharge. This 
discharge may be suppressed from various causes, and hence very 
opposite classes of remedies are employed to restore it. Thus, when 
amenorrhcea depends on anemia, the preparations of iron are the 
most effectual emmenagogues ; on the other hand, when it occurs 
in connection with plethora, blood-letting and evacuants are 
resorted to. There are probably no articles which exert any specific 
influence upon the catamenia, as the discharge from the uterus is 
not one of the excretions through which medicinal agents pass out 
of the system. Medicines, however, which excite the pelvic circu- 
lation and stimulate the organs in the neighborhood of the uterus 
have a tendency to increase or excite the menstrual discharge. 
They are — 

1. The mild acrid cathartics, as Aloes, etc. 

2. Many of the stimulating diuretics, particularly Cantharides. 

3. Some of the blennorrhetics, particularly Senega. 

4. Guaiacum, usually classed with the diaphoretics. 
Indirectly, the menstrual discharge rs frequently promoted by — 

1 . The preparations of Iron and of Manganese (especially Potas- 
sium Permanganate), which are the best emmenagogues in chlorotic 
and anemic cases. 

2. Mercurials, which prove emmenagogue from their influence 
in exciting the secretions generally. 

The following articles are employed exclusively as emmena- 
gogues : — 



EMMENA GOG UES—SA VINE. 421 



SABINA— SAVINE. 

Savine is the tops of Juniperus Sabina (Nat. Ord. Coniferas), 
a small evergreen bushy shrub of the south of Europe. They 
resemble closely the tops of Juniperus virginiana, the indigenous 
Red Cedar, which are sometimes substituted for savine in the shops. 
The latter has a greenish color, a strong, peculiar, heavy odor and 
a bitter, nauseous, resinous taste. Its virtues depend on a volatile 
oil, which is official. 

Physiological Effects. — Savine is a local irritant. Taken inter- 
nally, in medicinal doses, it stimulates the circulation and secretions, 
with a very decided secondary action on the uterus. In large doses 
it will cause vomiting, purging, abdominal pain, suppressed or 
bloody urine, with symptoms of nervous depression, as shown in 
unconsciousness, stertorous breathing, perhaps convulsions, and 
death, usually from collapse. 

Toxicology. — Fatal * results have occurred in several cases 
from its use to provoke premature labor. Toxic amounts induce 
violent gastro-enteritis. 

Medicinal Uses. — Savine is employed internally almost exclu- 
sively as an emmenagogue in amenorrhea, and it is considered one 
of the best medicines that can be used to stimulate the action of the 
uterine vessels, and its physiological action is intensified by combi- 
nation with oil of rue. Pereiraf pronounces it " the most certain 
and powerful emmenagogue of the whole Materia Medica." It has 
been successfully used in menorrhagia depending on relaxation of 
the uterine tissues. Topically, it is used to keep up the discharge 
from blisters, to destroy warts y etc. 

Administration. — Dose, in powder, gr. v-x ; but it loses much 
of its oil by drying; of the. fluid extract the dose is Til v-x. Ceratum 
sabince (fluid extract, 25 parts, resin-cerate, 90 parts) is used to 
make perpetual blisters. 

Oleum Sabinae {Oil of Savine) (C 10 H 16 ) is the preparation 
principally used internally. Dose, gtt. v-x — in capsules, pill or 
emulsion. 

Oleum Rutae (Oil of Rue) is a volatile oil distilled from Ruta 
graveolens (Nat. Ord. Rutaceae), a perennial European plant, with 



* '' A Treatise on Poisons," 4th ed., p. 605. Christison. 
j" Mat. Med. and Therap.," 4th ed., p. 332. 



422 MATERIA MEDICA AND THERAPEUTICS. 

tripinnate leaves, obovate leaflets and yellow flowers. The oil is a 
colorless or greenish-yellow liquid, of a characteristic, aromatic 
odor, a pungent, bitterish taste and a neutral reaction. It consists 
chiefly of ' methyl-nonyl-ketone (CH 3 .CO.C 9 H 19 ). 

Toxicology. — Two cases of non-fatal poisoning from an un- 
known quantity of decoction of the root, in females, followed by 
miscarriage, are recorded.* 

Effects and Uses. — Its action is similar to that of oil of savine, 
but is less powerful. It is prescribed in hysteria and amenorrhea. 

Administration.— Dose, gtt. ij-v every 3 or 4 hours. 

TAN ACETUM— TANSY. 

Tansy is the leaves and tops of Tanacetum vulgare {Nat. Ord. 
Composite), an herbaceous, perennial plant, indigenous to Europe 
but cultivated in our gardens and growing wild about waste places. 

Description. — The leaves are bipinnatifid, the segments cut- 
toothed, smooth, dark green ; the heads yellow, in a dense corymb, 
appearing in summer ; the odor is strongly aromatic and the taste 
pungent and bitter. 

Chemical Constituents. — It contains a volatile oil, tanacetin (a 
bitter-principle), resin, tannin, etc. 

Physiological Effects. — When the oil is given to animals in 
large doses, it causes vomiting, dilated pupil, muscular twitchings, 
followed by clonic convulsions and a cataleptic state with death from 
paralysis of the respiratory muscles. The lungs are found en- 
gorged, the left side of the heart empty and the kidneys much con- 
gested. In man, small doses induce a sensation of heat in the epi- 
gastrium flushing of face, giddiness and diuresis. In toxic doses it 
causes burning pain, vomiting and sometimes purging, loss of con- 
sciousness, violent convulsions of cerebral origin and death from 
respiratory paralysis. 

Toxicology. — Grave symptoms have been produced by gtt. xv 
of the oil ; but as recovery took place after 5jss had been taken 
the precise fatal dose is not known. An unknown but large 
quantity of tansy-infusionf taken by an adult negress to produce 
abortion caused her death, the symptoms being incoherence of 
speech, contracted pupils, hebetude, and finally paralysis of the vol- 



* " Woodman and Tidy," 1882, p. 358. 

t Med. Times and Gazette, April, 1861, p. 377. 



EMMENAGOGUES— TANSY. 423 

untary muscles, including those of deglutition, and lastly coma. 
The uterus was not affected, and stimulants failed to arouse her. 

Medicinal Uses. — It has been employed as a stimulating em- 
menagogue, but is an unsafe remedy. It has also been used to 
produce abortion, taken with criminal intent. 

Administration. — Dose, of the powder, gr. x-xxx in infusion ; 
of the oil, Tflj-ij. 

The following unofficial drugs enjoy a reputation as emmena- 
gogues : 

Apiol or Parsley Camphor is obtained from the volatile oil of 
the root of Petroselinum sativum (Nat. Ord. Umbelliferae). It oc- 
curs as a colorless or yellowish oil, having a strong odor of parsley 
and a pungent taste, and is soluble in alcohol, ether and chloroform, 
but not in water. It is said to be a mixture of several constituents 
(Maisch). 

Effects and Uses. — It has been used in amenorrhea of func- 
tional origin, especially when due to anemia, and is believed to be a 
stimulant to the ovaries. In neuralgic dysmenorrhea, it has also 
been given with success. It is prescribed in doses of gtt. v-vj 
enclosed in gelatin-capsules, morning and evening for four or five 
days before the expected menstrual period. 

Polygonum Hydropiperoides ( Water-Pepper or Smartweed) (Nat. 
Ord. Polygonaceae) is an indigenous herb, growing abundantly in 
moist places, with lanceolate, minutely pellucid-punctate leaves, and 
slender spikes of greenish or whitish flowers. It contains polygonic 
acid, etc. 

Effects and Uses. — When applied locally, it is an irritant, 
exciting inflammation and vesication if rubbed on the cutaneous 
surface. Internally. — It is a cardiac stimulant, diaphoretic, diuretic 
and expectorant, stimulating the menstrual flow, and it is aphro- 
disiac ; in large doses it causes nausea, vomiting and purging. 

It is strongly recommended by Dr. Eberle in functional amenor- 
rhcea and by others in functional impotence, and Dr. B. Woodward 
has used it with advantage in diarrhoea and dysentery. It has also 
been given as a diuretic to promote the expulsion of small renal 
calculi from the kidney and in gravel, and locally as a counterirritant. 

Administration. — A fluid extract is used in doses of Yftx-f 5j- 



424 MATERIA MEDICA AND THERAPEUTICS. 



CLASS III.— HEMATICS. 

ORDER I.— HEMATINICS. 

This order (from alfiariva, the red coloring matter of the blood) 
includes only the Preparations of Iron, or Chalybeates. The 
chalybeates increase the number of blood-corpuscles, or the amount 
of hematin in the blood, and are employed therapeutically in dis- 
eases dependent on a deficiency of these elements. They belong 
eminently to hematics (or medicines which occasion changes in the 
condition of the blood); but as they possess also general and local 
tonic effects, independent of their action on the blood, they have 
been classed and treated among the mineral tonics (see page 164). 

ORDER II.— ALTERATIVES. 

Alteratives may be defined to be medicines which produce such 
a modification of the nutritive processes as enables the vital princi- 
ple to restore healthy action in morbid conditions of the system. 
The modus operandi of these medicines is not understood. Perhaps 
their effects are owing to a correcting influence on the quality of 
the circulating fluid (thus, in inflammations they may act by 
diminishing the abnormal quantity of fibrin in the blood, rendering 
its red corpuscles less disposed to aggregation, and decreasing 
the number and adhesiveness of its white globules); perhaps their 
curative operation is of a substitutive character (by setting up an 
antagonistic action which takes the place of diseased action in the 
system); or perhaps they may attack diseased cells, causing their 
disintegration and rapid removal from the body by means of the 
excretions. 

Under the influence of alteratives the secretions and exhalations 
are increased, the textures softened, and morbid growths and depos- 
its are absorbed. The exudation of plastic or coagulable lymph is 
checked, and, as a consequence, also the formation of false mem- 
branes, and visceral and glandular enlargements and indurations are 
diminished and often disappear. 

If pushed too far, the alteratives soften and even destroy the 
textures, impoverish the blood so as to interfere with the functions 
of nutrition, and produce a condition of marasmus and cachexia. 

Their principal therapeutic employment is as antiphlogistic s or 
resolvents. The mercurials are chiefly employed in acute inflamma- 



AL TERA TIVES—PREPARA TIONS OF MER CUR V. 425 

tions ; the preparations of iodine in chronic inflammations. Mer- 
curials are used in acute sthenic inflammations, especially in such as 
have a tendency to terminate in effusions of lymph which would 
seriously interfere with the function of the part, by forming adhesions 
or false membranes. The iodic preparations are adapted to inflam- 
mations of a chronic character, and are particularly serviceable in 
indurations or enlargements of glands and organs, and in affections 
of the bones and fibrous tissues. 

Owing to the injurious results which follow the prolonged 
exhibition of alteratives, they are to be administered with caution, 
and their effects closely watched. 

HYDRARGYRI PR^PARATA— PREPARATIONS OF MERCURY. 

Metallic mercury or quicksilver is obtained principally from the 
red sulphide {cinnabar). The chief supply of quicksilver was long 
derived from Spain and Austria, but the markets of the United States 
are now furnished from New Almaden, in California. Mercury is an 
odorless, tasteless, volatile, liquid metal, of a whitish color. Its 
atomic weight is 199.7; its symbol is Hg. 

Incompatibles. — The chlorides and nitro-hydrochloric acid are 
incompatible with the metallic preparations of mercury. 

Aids. — Such purgatives as aloes and podophyllum enhance its 
cathartic action ; as an antisyphilitic, potassium iodide ; sedative 
agents, as antimony, promote its depressant action. 

Contraindications. — Mercurials are contraindicated in all 
asthenic inflammations, in renal disease or tuberculosis ; or where 
much debility exists. Even if such be distinctly referable to syphilis, 
caution must be enjoined in their use. 

Physiological Effects. — While it retains the liquid metallic 
state, mercury is inert ; but when taken internally it combines in the 
stomach and alimentary canal to form soluble and absorbable com- 
pounds — perhaps with the sodic chloride and albumen there present — 
and thus becomes active. In the blood it is said to exist as an oxy- 
albuminate. In the state of vapor it frequently proves injurious, in 
some instances exciting salivation, ulceration of the mouth, etc., in 
others inducing a peculiar affection of the nervous system termed 
shaking palsy (tremor mercurialis\ which is often attended with loss 
of memory, vertigo and other evidences of cerebral disturbance, and 
sometimes terminates fatally. Workmen in quicksilver are liable to 
this affection. It is supposed by some chemists that the activity of 



426 MATERIA MEDICA AND THERAPEUTICS. 

mercurial emanations is owing to the oxidation of the metal before 
it is inhaled ; by others, that, in the finely-divided state in which it 
exists as a vapor, it is in itself poisonous. 

All the compounds of mercury possess activity. Some of them 
are violent caustic poisons , all of them are more or less irritant. 
When the mercurials are taken internally their effects vary with the 
quantity administered. In small and repeated doses, their influence 
is first shown in an increase of the activity of the secernents and 
exhalants. The cutaneous, mucous, biliary, salivary, urinary, and 
probably also the pancreatic secretions are all increased in amount, 
and at the same time the absorbent system becomes more active, so 
that the accumulation of fluids, morbid enlargements, indurations, 
etc., will often disappear. It is by augu mentation of the secretions of 
the intestinal appendages that the mercurials prove purgative. 

Mercury increases the flow of bile. Most of the mercurial 
preparations probably accomplish this merely in a mechanical man- 
ner, i. e., by causing reflex contraction of the gall-bladder and ducts, 
due to the irritation of the mucous membrane of the duodenum ; 
but corrosive sublimate would seem, from the experiments of Ruth- 
erford and Vignal, to have considerable power as a stimulant of the 
hepatic secretory apparatus. 

When the mercurials are given in larger doses and for a period 
varying in length according to the susceptibility of the individual, 
these effects are more intense. The proportion of red corpuscles* 
is* diminished. The mucous membrane of the mouth and the 
salivary glands not only take on increased secretory action, but be- 
come irritated and inflamed. The gums first show the mercurial 
influence, and are tender and tumefied; the whole mouth *soon be- 
comes sore; the tongue is swollen; and the saliva and buccal 
mucus flow abundantly, sometimes to the extent of several pints 
a day. At the same time the breath acquires a peculiar fetidity, 
and the patient perceives a metallic taste in the mouth. The re- 
solvent action of the mercurials is now still more obvious than 
when its impression is milder, and considerable emaciation usually 
ensues from interference with nutrition and the absorption of fat. 
Formerly these effects, which are termed sialagogue (from the ex- 
cessive flow of saliva), were commonly produced for the cure of 



* " Report of Edin. Committee on the Action of Mercury on the Biliary Secretions," 
116, 2d ed., 1874. Hughes-Bennett. 



AL TERA TIVES—PREPARA TIONS OF MER CUR Y. 427 

disease, and, as a general rule, gradually subsided, leaving the 
health much impaired. When, however, the use of the mercurials 
is pushed too far, or it is administered to persons peculiarly suscep- 
tible to its action, a train of very serious symptoms ensues — as ex- 
cessive salivation, ulceration of the mouth, sloughing of the gums, 
loosening of the teeth, and occasionally necrosis of the alveolar 
processes. A peculiar febrile condition called mercurial fever, di- 
arrhoea, skin-diseases, neuralgia, rheumatism, disorder of the nerv- 
ous system, and marasmus, are other symptoms which are frequently 
noticed after the abuse of mercury. 

After their absorption the mercurials (and there is no doubt that 
they are absorbed,* since they have been found in the blood, saliva, 
liver, etc.) produce several important changes in the quality of the 
blood. Exceedingly minute doses given for some time, but not too 
frequently repeated, increase the proportion of red corpuscles in this 
fluid, and the bodily weight. This has been proven by Schlesingerf 
in an elaborate series of investigations upon dogs. Immediately 
upon the establishment of salivation, the blood exhibits an increase 
in the quantity of fibrin and red corpuscles ; but at a later period it 
loses color, consistence and coagulability, and the relative propor- 
tion of albumen, fibrin and corpuscles is diminished. This anti- 
plastic action on the blood renders the mercurials invaluable as 
antiphlogistic remedies. They are in part eliminated by the urine, 
feces and saliva. In the feces they pass out as a sulphide. 

Toxicology. — A non-fatal case in which Sivss of quicksilver 
was taken to produce abortion is reported by Sir G. D. Gibb.J the 
chief symptom being trembling palsy ; there was no salivation, col- 
oration on the gums or action on the uterus. 

Antidotes. — If salivation or ulceration occur, the drug must 
be stopped and astringent gargles, as brandy and water, solutions 
of chlorinated soda or lime, alum, etc. , may be employed. In cases 
of sloughing sores, silver nitrate, or the mineral acids should be 
applied. Gastro-enteric irritation is to be treated with laxatives 
and opiates. The mercurial cachexia requires change of air, gen- 
erous diet, tonics, etc. When the system is contaminated with 
mercury, it may be eliminated by the use of potassium iodide, which 



* " Mat. Med, and Therapeutics," Stille, II, i860, 782, quoted, 
f Arch, fur exper. Path. u. Pharmak., xin, 317. 
X The Lancet, London, I873, P- 339- 



428 MATERIA MEDICA AND THERAPEUTICS. 

forms soluble compounds with the mercury retained in the econ- 
omy. 

Medicinal Uses. — Liquid metallic mercury was formerly ad- 
ministered to remove mechanical obstructions of the bowels, but 
its use has been abandoned. The preparations of mercury are em- 
ployed therapeutically with various objects : — 

i. As indirect tonics and cholagogues — with a view to their 
action on the secretions — in dyspepsia and constipation accom- 
panied with torpor of the liver, in gout, rheumatism, chronic skin 
diseases, etc. Blue pill, mercury with chalk, and calomel, are em- 
ployed with this view : the two former are preferred as least 
irritating. 

2. As antiphlogistics. — Mercury was formerly given in nearly 
all cases of sthenic inflammation with a tendency to plastic effusion. 
At present, however, its use as an antiphologistic is principally re- 
stricted to acute inflammation of the serous membranes of sthenic 
type during the stage of exudation, and after the plastic effusion 
has ceased to be poured out with a view to prevent its organiza- 
tion and facilitate absorption. In this way it is given in pleuritis, 
pericarditis and peritonitis, and with a similar view in pneumonitis, 
and iritis. Many writers, however, relying on other remedies, de- 
precate the use of mercurials in the treatment of these diseases, with 
the exception of iritis, in which they are universally acknowledged 
to be of benefit. Minute doses of the mercurials, frequently repeated, 
are highly recommended in acute glandular affections about the 
throat and neck, as tonsillitis, parotitis, etc. In acute sthenic dys- 
entery, a mercurial — especially calomel — may often be given with 
advantage. When given with a view to their antiplastic effects, it 
is no longer thought necessary to cause profuse salivation; it is 
sufficient to produce the constitutional effects as manifested by a 
metallic taste in the mouth, very slight tumefaction of the gums 
and slight tenderness of the teeth when knocked together forcibly. 
During the maintenance of this condition the patient should use 
warm clothing, avoid exposure to cold, and take light and nourish- 
ing food. 

3. As antisyphilitics. — Mercury has long been regarded as the 
only reliable syphilitic agent. So far no satisfactory explanation 
has been made as to its mode of action. Hughes-Bennett (loc. cit.) 
and Wilbouchewitch* have shown that the blood of syphilitics who 

* Arch, de Physiol. Norm, et Pathol. 2d ser., 1, 1874, 509. 



AL TERA TIVES—PREPA RA TIONS OF MER CUR Y. 429 

were taking mercury underwent an increase in the number of red 
globules. It has no direct curative influence on the primary symp- 
toms; but after the system has been contaminated with the syph- 
ilitic virus, mercury is the most certain and rapid means of destroy- 
ing it. Formerly, wherever the chancre, with distinct induration 
(which is indicative of constitutional taint), was present, the mercurials 
were administered, but, as it is now generally conceded that the in- 
itial lesion is but a local manifestation of a constitutional disease, in 
other words, that the patient's system is affected with the disease, 
when the chancre first appears, and as mercury does not prevent 
the secondary symptoms, but merely modifies them in such a man- 
ner that no prognosis can be formed from the variety or date of 
appearance of the syphilides, it is recommended to withhold mer- 
curials until the secondary lesions manifest themselves (H. Morris). 
Some high authorities, however, adhere to the rule of administer- 
ing mercury from the first appearance of the chancre. Hutchinson's* 
" abortive treatment of syphilis " Consists in the administration of 
gray powder (q. v.) as soon as the diagnosis is verified by the in- 
duration around the sore, for the purpose of entirely suppressing 
the secondary symptoms. ' He believes mercury is antagonistic to 
the microbe of syphilis. Von Zeissl'sf teaching is to wait eight or 
ten weeks after the first eruption has appeared, and then to give it by 
inunction. I do not agree with this doctrine, for it seems irrational 
to allow the disease to gain so much headway (C. Biddle). Ross J 
advises it to be given " when the base of the primary ulcer is thick- 
ened," as it stimulates the tissues surrounding the ulcer to increased 
action, but he offers no evidence to prove the latter statement. I 
am of opinion that as soon as the diagnosis of syphilis is pos- 
itively made certain, and in this statement I am in accord with the 
view of Verneuil, § and Hutchinson {loc. cit.), by the character of 
the ulcer, its period of incubation, the presence of a non-suppurating 
bubo, and possibly by confrontation, it is time to begin a mercurial 
course, small in dose, continued usually for a lengthy period (two and 
a half years), occasionally intermitted, and in semi-metallic form, as 
blue mass or gray powder (C. B.). In the treatment of hereditary 
syphilis, a mercurial course is indispensable. In tertiary syphilis, 
small doses of corrosive sublimate are often combined with potas- 



Lancet, Feb., 1888, p. 372. f " Path, and Treat, of Syphilis/' 1886, p. 335. 

% The Practitioner, V, p. 220. $ Bull. Gen. de Therap., Oct , 1887. 



430 MATERIA MEDIC A AND THERAPEUTICS. 

sium iodide with better effects than when the iodide is given alone; 
after the tertiary symptoms have disappeared the mercurials should 
be continued for eighteen months, with the occasional intermission 
of the treatment for two or three weeks. Mercurials may be used 
not only internally, but by inunction and by fumigation, for Dr. 
Fiirbringer has shown that, although metallic mercury will not pass 
through the skin, yet when rubbed into the sebaceous follicles the 
sebaceous matter converts it into a soluble mercurous compound, 
which is then readily absorbed; and by hypodermic injection. 

Blue pill and calomel are the antiplastics principally resorted 
to ; as antisyphilitics, both the iodides, corrosive sublimate, gray 
powder and calomel are employed. In administering mercurials 
for their sialagogue action, we sometimes observe a cumulative 
effect; they may be exhibited, particularly to children, for some 
time without result, when suddenly the most violent symptoms of 
mercurial saturation will be developed. 

4. As purgatives. — The employment of calomel and blue pill, 
as cathartics and anthelmintics, has been previously noticed (see 
index). 

The following are the preparations of mercury which are em- 
ployed medicinally : — 

1. Metallic Mercury. — When intimately mixed with pulveru- 
lent or fatty bodies, mercury loses its liquid character — is said to be 
killed, extinguished or mortified— and acquires medicinal activity. 
Jts activity is probably owing to its reduction to a state of minute 
division, which enables it to enter into combinations in the stomach. 
As more or less oxidization has always taken place in the metallic 
preparations before use, their composition is uncertain. The 
official preparations of metallic mercury are : Massa hydrargyri 
{mass of mercury), unguentum hydrargyri (mercurial ointment), em- 
plastrum hydrargyri (mercurial plaster), emplastmm ammoniaci cum 
hydrargyro (ammoniac plaster with mercury), hydrargyrum cum 
cretd (mercury with chalk). 

2. Oxides. — Hydrargyri oxidum flavum (yellow mercurial oxide) 
unguentum hydrargyri oxidi flavi (ointment of yellow mercurial oxide), 
oleatum hydrargyri (oleate of mercury), hydrargyri oxidum rubrum 
(red mercurial oxide), unguentum hydrargyri oxidi rubri (ointment of 
red mercurial oxide). 

3. Chlorides. — Hydrargyri chloridum mite (mild mercurial 



A L TERA TIVES—PREPARA TIONS OF MERCUR Y. 431 

chloride i or calomel\ hydrargyri chloridum corrosivum {corrosive, or 
mercuric chloride, or corrosive sublimate). 

4. Iodides. — Hydrargyri iodidum viride {green mercurial iodide} 
hydrargyri iodidum rubrum (red mercurial iodide). 

5. Hydrargyri cyanidum (mercurial cyanide). 

6. Hydrargyrum ammoniatum (ammoniated mercury), unguen- 
tum hydrargyri ammoniati (ointment of ammoyiiated mercury). 

7. Hydrargyri sub sulphas flavus (yellow mercurial subsulphate). 

8. Hydrargyri sidphidum rubrum (red mercurial sidphide). 

9. Nitrates. — Unguentum hydrargyri nitratis (oifitment of mer- 
curial nitrate), liquor hydrargyri nitratis (solution of mercurial 7iitrate). 

Massa Hydrargyri (Mass of Mercury). This preparation, gen- 
erally known as blue mass, is made by rubbing mercury (33 parts) 
with honey of rose (34 parts) and glycerin (3 parts) till all the glob- 
ules disappear ; then adding powdered glycyrrhiza (5 parts) and 
althaea (25 parts), and beating the whole into a mass. The tritura- 
tion is now generally effected by machinery — usually by steam- 
power. It is a soft, dark-blue mass, of a convenient consistence for 
making it into pills. The mercury is in a state of minute division, 
and is chemically unaltered, though, perhaps, a very small portion 
of it is in a state of oxidation. The preparation changes color 
from being kept, becoming of an olive and even reddish tint, in 
consequence of the further oxidation of the metal. As it is often 
adulterated, it is important that it should be purchased of a reliable 
house. 

Toxicology. — In the case of an adult female, * gr. xviij caused 
death, the chief symptom being profuse salivation — a very excep- 
tional instance. 

Effects and Uses. — In full doses (gr. v-xv) blue pill acts as a 
laxative ; when given for this purpose it is usually followed in a few 
hours by a saline cathartic. This plan is very efficient in migraine 
and biliousness. In doses of gr. j-ij-iij, repeated at proper intervals, 
it is employed as an alterative or antiphlogistic. When it moves the 
bowels, opium is combined with it. It may be pleasantly given 
suspended in mucilage or syrup. Blue mass is an efficient anti- 
syphilitic agent, and is often well combined with iron and quinine 
as in the following prescription : 1^ Massae hydrargyri, gr. %!-^ ; 
ferri sulphatis exsiccati et quininae sulphatis, aa gr. j ; extracti opii, 

* The Lancet, 1838, 215. 



432 MATERIA MEDICA AND THERAPEUTICS. 

gr. -y&. M. et ft. pil. j. Sig. — One pill half hour after meals; it 
has the advantage also of being in the metallic state, which was the 
form preferred by the late Dr. Bumstead. 

Unguentum Hydrargyri {Mercurial Ointment) (also called 
blue ointment) is made by rubbing mercury with compound 
tincture of benzoin and mercurial ointment, then adding suet and 
lard, previously melted together, and continuing to rub until the 
globules disappear. It is an unctuous, fatty body, of a bluish-gray 
color, consisting of equal weights of fatty matter and finely divided 
mercury. A very small portion of mercurous oxide is perhaps 
present, and, as the ointment becomes darker by age, a further oxida- 
tion of the mercury probably takes place. 

Effects and Uses. — Mercurial ointment, when either swallowed 
or rubbed into the integument, slowly produces the constitutional 
effects of mercury; locally, it has but little irritant effect. It is 
scarcely ever used internally in the United States or Great Britain, 
though in France it is highly esteemed as a sialagogue, in the dose 
of gr. ij, repeated. Externally it is used to mercurialize the system 
by friction; to disperse non-malignaiit tumors; as a dressing to 
syphilitic sores; to destroy pediculi; and to prevent the suppuration 
and pitting of smallpox. When mercurial inunction is about to be 
practiced in the treatment of secondary syphilis, the part to which the 
ointment is to be applied should be washed with castile-soap and 
warm water to free the skin from oily matters. Sigmund, of 
Vienna, the great advocate for this plan of treatment, recommends 
that the inunctions (gr. xx. 5ss.), be applied to different parts of the 
body; thus, during five successive nights this treatment would be 
practiced on the legs, on the thighs, on the abdomen and sides of 
the chest, on the back, on the arms, and on the sixth night he would 
apply the inunction to the legs again. The rubber should wear a 
glove to guard against the absorption of mercury. This plan of 
treatment is troublesome and filthy, and has not been generally 
used, but in certain cases, where mercury cannot be taken internally, 
or does not effect a cure, it is of much value. During the course 
the patient should remain indoors and keep at rest upon a sofa. 
Another method is to thoroughly rub the ointment into the soles 
of the feet every night for a week, when the inunction should be 
omitted for three nights, after which the process may be repeated. 
About gr. xv-xxx are required each night, and it is best to apply 
it to the feet alternately. 



AL TERA TIVES—PREPARA TIONS OF MER CUR Y. 433 

Empiastrum Hydrargyri {Mercurial Plaster) is made by rubbing 
30 parts of mercury with 10 parts of olive-oil and resin each, previ- 
ously melted together, till the globules disappear, and then adding 
50 parts of melted lead-plaster. It is used as a discutient of scrofu- 
lous and syphilitic enlargements, to enlarged joints, to prevent pitting 
in smallpox, etc., and is applied to the side in chronic hepatitis ; it 
may induce salivation. The plaster of ammoniac with mercury [em- 
piastrum ammoniaci cum hydrargyro) is more stimulating than the 
foregoing. 

Hydrargyrum cum Creta {Mercury with Chalk) (called also gray 
powder), is prepared by rubbing 38 parts of mercury with 50 parts of 
prepared chalk and 12 parts of sugar of milk, till all the globules dis- 
appear. It is a grayish powder, containing mercury chiefly in a 
state of minute division. 

Effects and Uses. — In full doses it is a gentle laxative, milder 
even than blue pill; in smaller doses it is an excellent alterative; 
and the chalk renders it antacid. It is employed in infantile cases 
chiefly as an alterative. In congenital syphilis gr. ^ may be given 
three times a day. Gray powder is Mr. J. Hutchinson's* favorite 
remedy in secondary syphilis, as follows : 1^ Hydrargyri cum creta, 
pulveris ipecacuanhas et opii, aa gr. j. M. et ft. pil. 1. Sig. — One 
every 6, 4, 3, or even 2 hours. He advises this preparation of mer- 
cury to be used for a long period, but always in small doses. 

Administration. — Dose, for adults, gr. v-xx ; for children, 
gr. ij-iij to gr. viij-x in powder, and not in pills, as in the latter form 
the mercury becomes squeezed out of the chalk. 

Hydrargyri Oxidum Rubrum (Red Mercuric Oxide) (HgO). It 
is made usually by dissolving mercury in diluted nitric acid, with a 
gentle heat, by which mercuric nitrate is formed; and the nitric acid 
is afterward decomposed and driven off by calcination. The mer- 
curic oxide, commonly called red precipitate, occurs in small, shining 
scales, of a brilliant red color, with a shade of orange. It has an 
acrid taste, and is nearly insoluble in water. Its effects are those of 
a powerful irritant, and when taken internally, even in small doses, 
it excites vomiting and purging; in large doses, gastro-enteritis. 

Toxicology. — An instance of non-fatal poisoning f is recorded 
in the case of a female aged 15, who swallowed probably ^}i, the 



* "On Syphilis," i887, p. 51. 
| Irish Hosp. Gazette, 1, 1873, P- 3°8. 
28 



434 MATERIA MEDIC A AND THERAPEUTICS. 

ingestion of which was only followed by some abdominal pain, mer- 
curial fetor of breath, sore mouth and gums. 

Effects and Uses. — It is rarely or never used internally ; ex- 
ternally it is applied as an escharotic, either in powder or ointment, 
to chancres, indolent ulcers, etc. 

: . Administration. — Dose gr. tV— yi ; unguentum hydrargyri 
oxidi rubri [ointment of red mercuric oxide) consists of red oxide (10 
parts) mixed with ointment (90 parts) ; it is a very useful stimulat- 
ing ointment in indolent tdcers and porrigo. 

Hydrargyri Oxidum Flavum ( Yellow Mercuric Oxide) is made by 
mixing a solution of corrosive sublimate with solution of potassa ; 
potassium chloride is formed in solution, and mercuric oxide (HgO) 
is precipitated as an orange-yellow powder, which, on being heated, 
assumes a red color. The yellow oxide is without odor, of an acrid 
taste, is very slightly soluble in water, and is insoluble in cold alco- 
hol and ether. 

Effects and Uses. — This preparation is preferred for some 
purposes to the red oxide, owing to its greater purity, and especially 
to its occurring in the form of a completely amorphous poivder, exhib- 
iting no evidence of crystalline particles even under the microscope. 
This gives it a superiority, as a local application to the conjunctiva, 
in diseases of the eye, over the red oxide, which, from the crystalline 
character of its particles, causes more or less irritation. Unguentum 
hydrargyri oxidi flavi (ointment of yellow mercuric oxide) consists of 
yellow oxide, 10 parts, mixed with ointment, 90 parts; an efficient 
application in opacity and ulcer of the cornea, to remove the granu- 
lations of ophthalmia, and to the margin of the lid in blepharitis after 
the removal of the crusts. Oleatum hydi'argyri (pleate of mercury) 
consists of yellow oxide, 10 parts, dissolved in oleic acid, 90 parts, 
by means of heat. In the treatment of secondary syphilis it may be 
used by inunction as a substitute for mercurial ointment. For this 
purpose 20 per cent, in solution should be painted on the part, or it 
may be mixed with petrolatum in the same proportion, and applied 
with mild friction. In infantile cases an ointment containing 5 per 
cent, of the oleate may be applied by means of roller bandages once 
a day. H. W. Stelwagon* finds the oleate inferior to blue ointment 
when applied locally for its constitutional effects, but lauds its use 
in ring-worm of the scalp, [t is also useful to relieve pruritus. 

^ Am. Jo urn. Med. Set., Oct., 1885. 



AL TERA TIVES—PREPARA TIONS OF MER CUR Y. 435 

YtUowwash (a favorite application to phagedenic chancroids) consists 
of yellow mercuric oxide suspended in a weak solution of calcium 
chloride, and is made by adding corrosive sublimate Sj to lime-solu- 
tion Oj. Black wash (a favorite application to chancres, mucous 
patches, balanitis, herpes and prickly heat) is an impure mercurous 
oxide (Hg 2 0) in a weak solution of calcium chloride, and is made 
by adding calomel Sj to lime-solution Oj. In the treatment of 
vesicular eczema, an efficient plan is to cleanse the parts with black 
wash, and then to apply zinc oxide ointment — all to be repeated 
according to circumstances. 

Hydrargyri Chloridum Mite {Mild Mercurial Chloride). This 
preparation (mercurous chloride), well known as calomel (Hg 2 Cl 2 ), is 
made by subliming a mixture of mercurous sulphate and sodium 
chloride (common salt); a double decomposition takes place, by 
which mercurous chloride and sodium sulphate are formed. The 
mercurous sulphate is previously obtained by boiling mercury in 
sulphuric acid, and afterward triturating the resulting mercuric sul- 
phate with mercury. Calomel, as thus procured in mass, is liable to 
contain a little corrosive sublimate. It should be reduced to powder, 
and washed repeatedly with boiling distilled water until the absence 
of a white precipitate with ammonium hydrate shows that the cor- 
rosive sublimate has been removed. With a view of obtaining 
calomel in a state of very minute division, its vapor is condensed 
in a receiving vessel filled with steam, whereby it takes the form 
of a very fine powder, and is perfectly free from corrosive sub- 
limate. The calomel thus prepared (known as Jewell's or Howard's 
calomel) is finer and more active than can be obtained by levigation 
and elutriation. 

Chemistry and Tests. — Calomel, as usually manufactured by 
sublimation, is in the form of white, fibrous, crystalline cakes. It 
may be obtained in the shape of quadrangular prismatic crystals. 
As found in the shops it is a light-buff or ivory-colored powder, 
tasteless, inodorous, insoluble in water, alcohol and ether, unalter- 
able in the air, but blackening by exposure to light, showing decom- 
position. It should be kept in bottles painted black or covered with 
black paper. JeweWs calomel is a perfectly white powder. Jests, 
— When pure, calomel is completely vaporizable by heat; it strikes 
a black color, free from reddish tinge, with solutions of the fixed 
alkalies ; and should not, when digested with water, form a white 
precipitate with ammonia, unless it contain corrosive sublimate. 



436 MATERIA MEDICA AND THERAPEUTICS. 

Calomel is insoluble in ether, corrosive sublimate moderately soluble 
in this menstruum. 

Incompatibles. — The alkalies, alkaline earths, alkaiine carbon- 
ates, soaps, and sulphydrates are incompatible with calomel. Nitro- 
hydrochloric acid should not be prescribed with it, for fear of gen- 
erating corrosive sublimate. Preparations containing hydrochloric 
acid, and potassium, ammonium or sodium chloride, produce the 
same change. 

Physiological Effects. — Calomel produces the effects of the 
mercurials already described, causing bilious stools, not from direct 
stimulatiom of the liver, but probably in a reflex manner; it stimu- 
lates too the intestinal glands, and in purgative doses proves a valu- 
able anthelmintic. It agrees well with the stomach, and will often 
be borne when other purgatives would not be tolerated. It is as- 
serted that calomel is converted into corrosive sublimate in the 
stomach by the hydrochlaric acid which it there encounters, but 
there are many reasons for rejecting this hypothesis, and more 
probably it unites with the albuminous peptones there present, 
forming a compound which is soluble in the gastric fluid. 

Toxicology. — Calomel has been frequently taken in very large 
doses without any bad effects ; but instances are recorded in which, 
in excessive quantity, it has acted as an irritant poison. In the case 
of a boy * aged 14, gr. vj, and in the cases of two lads f of 12 and 
15, gr. xv caused death ; but such examples must be considered as 
very unusual. 

Medicinal Uses. — From the certainty and mildness of its 
operation it is more employed than any of the other preparations 
of mercury, although blue pill, which, if less certain, is milder, is 
preferred under some circumstances. As a purgative it is prescribed 
in doses, of gr. vj-xij in fevers , enteritis, yellow fever, and many other 
affections ; gr. ss-j at bedtime will often prove sufficiently purgative 
in the morning ; as an anthelmintic, against round and thread-worms 
in the same doses ; and in both cases it is to be followed in a few 
hours by a saline draught, castor-oil or senna. Calomel is often 
given in combination with other cathartics, as jalap, rhubarb, aloes, 
scammony, colocynth and gamboge. In the treatment of secondary 
syphilis it is the favorite remedy of many, and may be given gr. 



*" Med. Jurisprudence," Taylor, 5th ed., p. 98. 

f A Treastise on Poisons," Christison, 4th ed., p. 428. 



AL TERA TIVES-PREPARA TIONS OF MER CUR Y. 437 

1*3, tV, 3 to 4 times daily. As an antiphlogistic in inflammatory cases, 
calomel is given in doses of gr. ss^-j every one, two or three hours ; 
as an eccritic, in these doses twice or thrice a day. In the dose of 
gr- t\>-J> frequently repeated, it is one of the best means of checking 
obstinate vomiting and nausea; similar doses with sodium bicar- 
bonate gr. j may be sprinkled on the tongue every half hour, which 
will often be of great service in the gastric irritability and catarrh 
following the ingestion of indigestible food, after the contents of the 
stomach have been evacuated; and in cholera morbus. In jaundice 
due to catarrh of the bile ducts calomel gr. T Vi every 3 or 4 hours 
may be given with advantage to allay irritation of the duodenal and 
biliary mucous membranes. It is sometimes added to other medi- 
cines to increase their action on the secretions, as to squill or 
digitalis, and has been lauded as a diuretic in cardiac dropsy. 
Cohn's * clinical investigations, however, have not led him to place 
much reliance on calomel as a diuretic in cardiac and other dropsies.; 
As the diuretic action of the mercurial preparations seems to de- 
pend upon their stimulant action on the liver, leading to the in- 
creased formation of urea, as in the case of other cholagogues,t and 
as Rutherford has shown that calomel is not a true hepatic stimulant, 
it is probable that either some some of the corrosive chloride was 
present in the calomel, causing diuresis, or that the latter was trans- 
formed into that salt in the alimentary canal.J To children, calomel 
may be given in proportionally larger doses than to adults,* and it 
rarely salivates them. In some cases of infantile diarrhoea, very, 
minute doses of calomel, as gr. T V, T V, I, every hour or two, are 
highly efficacious. Externally, calomel is applied in powder, 
in opacity of the cornea; and made into an ointment (5j to Sj lard), 
it is an excellent application in a variety of cutaneous affections, 
as herpes. It is also used in the treatment of secondary syphilis 
by fumigation. For this purpose calomel 5ss may be volatilized 
in a water-bath placed beneath a cane-bottomed chair on which 
the patient is seated, without his clothes, but wrapped to the 
neck in blankets which should envelop the chair and apparatus. 
The patient should sleep in the blanket in which he was wrapped 
during the fumigation. 

•" Ueber die diuret. Wirkung des Calomel," Inaug.-Dissert., Berlin, 1887. 
| Brit. Med. Journ., Feb., 1886, pp. 377 and 433. See abstract of Report by Dr. Noel 
Paton to Scientific Grants Committee of the British Medical Association. 
% Practitioner, Sept., 1886, Spiller Locke. 



438 MATERIA MEDICA AND THERAPEUTICS. 

Hydrargyri Chloridum Corrosivum (Corrosive Mercurial Chloride). 
This is mercuric chloride, commonly called corrosive sublimate (Hg 
Cl 2 ). It is made by subliming a mixture of sodium chloride and 
mercuric sulphate (which is previously obtained by boiling mercury 
with sulphuric acid) double decomposition takes place, resulting in 
the formation of mercuric chloride and sodium sulphate. 

Chemistry md Tests. — Corrosive sublimate occurs in the 
form of white, semi-transparent, crystalline masses, permanent in 
the air, inodorous, and of an acrid, styptic taste. It is soluable in 
1 6 parts of cold water or 2 parts of boiling water, more soluble in 
alcohol, and still more so in ether. The aqueous solution, when 
exposed to light, is decomposed, with the precipitatioa of calomel 
and evolution of hydrochloric acid. The tests for detecting corro- 
sive sublimate in solution are: i. A solution of potassa, soda or 
lime throws down a yellow precipitate ; 2. Potassium carbonate, a 
brick-red precipitate ; 3. Ammonia, white ammoniated mercury ; 
4. Potassium iodide, a bright scarlet-red mercuric iodide, readily 
soluble in excess of the precipitant; 5. Stannous chloride, in small 
amount, a white precipitate of calomel — in excess, a dark-gray pre- 
cipitate of metallic mercury ; 6. Sulphuretted hydrogen, or a sul- 
phide, in minute amount, produces a whitish or gray precipitate, 
and in large amount a black sulphide ; 7. If the solution be acidu- 
lated with hydrochloric acid and gently heated, bright copper-foil, 
when plunged into it, becomes coated with a silvery-white deposit 
of mercury ; and the metal may be afterward obtained by sublima- 
tion in a test-tube in the form of globules. The above is the 
method of obtaining mercury from organic mixtures, and it will 
detect about tooWo of a grain (Wormley*). The deposit on the cop- 
per-foil must be distinguished from deposits of arsenic and anti- 
mony, which are obtained in the same way. Under the microscope 
the mercury sublimate appears to be globular, the antimony amor- 
phous and the arsenic in octahedral crystals. 

Incompatibles. — It is incompatible with many of the metals, 
the alkalies and their carbonates, soap, lime-solution, tartar emetic, 
silver nitrate, the lead acetates, potassium and sodium iodides, the 
sulphides generally, syrup of sarsaparilla, and with many vegetable 
substances (as the bitters) and albuminous liquids (as milk, etc.). 

Physiological Effects. — In medicinal doses, gr. ^ — §-, corro- 

*" Micro Chemistry of Poisons," 1885, p. 352. 



AL TERA TIVES—PREPARA TIONS OF MER CUR Y. 439 

sive sublimate occasions a beneficial alterative effect, without any- 
obvious activity. It is a true hepatic stimulant of considerable 
power, increasing also the formation of urea and uric acid, and thus 
acting as a diuretic,* and likewise feebly stimulating the intestinal 
glands. Its continued use may cause salivation, but it has less ten- 
dency to produce this result than any other preparation of mercury. 
Medicinal doses, if too large or too long continued, frequently pro- 
duce gastro- enteric symptoms and the constitutional effects of mer- 
cury. 

Toxicology. — In excessive doses corrosive sublimate is a vio- 
lent caustic poison, from its affinity for the albumen, fibrin and other 
constituents of the tissues. It acts very rapidly, producing the 
most intense gastro-enteritis, with violent vomiting and purging, ab- 
dominal pain and tenderness, bloody stools, with death from collapse, 
or, after a time, with convulsions and coma. The urine is albu- 
minous or bloody, diminished in amount or suppressed. 

The precise fatal quantity cannot be stated, for in a number of 
cases the toxic amount has varied widely ; for instance, Taylorf re- 
ports the death of a child from gr. iij ; HerapathJ records a fatal 
case from gr, xx in solution, in the case of a man ; while a girl§ of 
eighteen recovered after swallowing about gr. xix. ■ 

Antidotes. — The best antidote is albumen (in the form of white 
of eggs); or, if this is not attainable, gluten (in wheaten flour) or cas- 
ein (in milk) maybe substituted. Ferrous sulphide (if given imme- 
diately), and a mixture of iron-filings (two parts) with gold dust (one 
part), also decompose corrosive sublimate. In cases of poisoning, 
the stomach must be evacuated as soon as possible, and the after- 
treatment consists in the free use of demulcents (linseed-tea, or 
mucilage of acacia), and opiates. 

Medicinal Uses. — Corrosive sublimate is used chiefly as an 
alterative or antagonistic agent in seco?idary syphilis, both by the 
stomach and occasionally by hypodermic injection ; and also in 
cutaneous and rheumatic affections; it is a good remedy, too, in 
chronic diai-rhcea and dysentery with slimy and bloody discharges. 
In tertiary syphilis it is combined advantageously with potassium 
iodide, as in the following : Jfy Hydrargyri chloridi corrosivi, gr. 
iss; potassii iodidi, 5ij ; elixir aurantii, f 5ij; aquae ad fovj. M. 



* Practitioner, Sept , 1886. f *' Medical Jurisprudence," 1865, p. 225. 

J The La7icet, 1845, p. 650. § Guy's Hosp. Reports, 1851, p. 212. 



440 MATERIA MEDICA AND THERAPEUTICS. 

Sig. — f5ij,in water, t. d., after meals. The dose, when alone, is gr. 
Yt—k three or four times a day, after meals, in pill ; or, if in solution, 
disguised by elixir of orange. It has also been used hypodermic ally 
in syphilis. For this purpose various solutions have been used. Jfy 
Hydrargyri chloridi corrosivi, gr. j ; aquae destillatae, f§j. M. Of 
this solution Tttx contain gr. ¥ \. As the injection of corrosive 
sublimate is followed, in many instances, by inflammation and 
abscess, and as it seems to have no decided advantage over the 
other methods, we do not advise its adoption. 

When used hypodermically mercury is claimed to be more 
energetic, efficient, and rapid in its action than when administered 
either by the mouth, by inunction, or by fumigation. 

M. Martineau, who has employed it largely in syphilis, declares 
there is neither pain, phlegmon, abscess nor stomatitis (with- 
out there was previously an unhealthy condition of the buccal mu- 
cous membrane), and no gastro-intestinal disturbance, when the 
solution is neutral, the needle fine and very sharp, and the injection 
made in the dorsal region. Though highly recommended by num- 
erous syphilographers, the hypodermic use of mercury has not 
gained much favor with the profession at large, and it is principally 
employed only when mercurials are not well borne by the mouth or 
by inunction, or do not effect a cure. The average dose for hypo- 
dermic use is gr. T V- T V- Externally it may be used as a caustic. 
It is destructive to the lower forms of life, and hence may be used 
as an antiseptic in weak solution (i part to 2000 parts of water, or 
about gr. j-fgivss, vide Antiseptics), instead of carbolic acid ; a 
weak solution (gr. J^-j-ij to water f§j) is much employed as a 
wash to ulcers , an injection in gleet, and to remove freckles. An 
ointment (gr. j£- j-ij to lard §j) is a good application in porrigo, 
tinea, eczema, phthiriasis, and skin diseases generally of parasitic 
origin. There is danger from the external application of corrosive 
sublimate to a large surface. 

In gonorrhoea after the acute stage has passed, corrosive subli- 
mate, gr. A— I m water, foviij is an excellent injection, and accord- 
ing to Koch is the most effective agent with which to kill the 
gonococci. After the first trial the strength should be regulated 
just short of irritating the urethra. 

As a tineacide in ringworm the strength may be gr. iij-v in an 
ounce of the compound tincture of benzoin, the solution to be 
applied every few days with a brush. The parts should first be 



AL TERA TIVES—PREPARA TIONS OF MERCUR Y. 441 

cleansed with sapo viridis, or an alkaline lotion. The following 
is serviceable to destroy pediculi: 1^ Hydrargyri corrosivi sublimati, 
gr. vj ; acidi acetici diluti, f5ij ; aquae, a'd fgiv. M. Sig. — Apply 
with a sponge morning and evening. The acid is added to dissolve 
the nidus of the lice around the base of each hair-shaft. 

Hydrargyri Iodidum Viride [Green Mercurial Iodide) (Mercur- 
ous Iodide) (Hg 2 I 2 ) is made by rubbing mercury and iodine together, 
with the addition of a little alcohol. It is a greenish-yellow pow- 
der, insoluble in water, alcohol and ether. By exposure to light it 
is partially decomposed, and becomes of a dark olive color. 

Effects and Uses. — This mercurial exercises a specific influ- 
ence over the lymphatic and glandular systems, and is employed in 
syphilis and scrofula. It is a favorite with many practitioners in the 
treatment of the syphilides : It Hydrargyri iodidi viridis, gr. iv ; 
morphinae sulphatis, gr. j. M. et ft. pil. xx. One of these pills 
may be given one-half hour after meals, and the dose gradually in- 
creased by one pill per day until tenderness of the gums, or gastro- 
intestinal symptoms supervene, when the quantity must be lessened. 
Externally, it is applied in the form of ointment, to syphilitic idcers y etc. 
Dose, gr. %-]. 

Hydrargyri Iodidum Rubrum (Red Mercuric Iodide) (Hgl 2 ) 
is made by mixing solutions of potassium iodide and mercuric 
chloride, from which a double decomposition ensues, resulting in 
the formation of potassium chloride in solution, while red (mercuric) 
iodide is precipitated. It is a scarlet red powder, which becomes 
yellow when heated, insoluble in water, but soluble in boiling alco- 
hol and solutions of potassium iodide and sodium chloride. It is a 
powerful irritant and caustic, and is employed in the same cases as 
the green iodide, though much more energetic. It is useful in 
syphilitic rheumatism. In late secondary or in tertiary syphilis the 
following prescription is often of service : 3^ Hydrargyri iodidi 
rubri, gr. iij ; potassii iodidi, 5ij ; elixir aurantii, fSiij ; aquae des- 
tillatae, q. s. ad Sviij. M. et Sig. Take a teaspoonful 3 times a day. 

Administration. — Dose, gr. T \, gradually increased to gr. J^, 
in pill or alcoholic solution; or, still better, dissolved in a solution 
of potassium iodide. Externally, it may be used in the form of 
ointment (gr. xvj mixed with ointment 5j), and as an antiseptic 
agent (q. v.) 

Hydrargyri Cyanidum (Mercuric Cyanide). This salt is made by 
adding a solution of potassium ferrocyanide to sulphuric acid, by 



442 MATERIA MEDICA AND THERAPEUTICS. 

which hydrocyanic acid is produced, and this, being received in a 
vessel containing water and red mercuric oxide, generates water and 
mercuric cyanide (Hg(CN) 2 ). It is found usually in the form of 
permament, prismatic, white and opaque crystals, of a disagreeable 
styptic taste, soluble in water, less so in alcohol. 

Toxicology. — It is an active poison, two fatal cases being re- 
ported by Christison,* one from gr. x, the other, gr. xxiijss. 

Medicinal Uses. — It is used as an antisyphilitic remedy, as a 
substitute for corrosive sublimate, over which it has the advantage 
of not producing epigastric pain, and of not being decomposed by 
the alkalies and organic substances. Dose, gr. T V to y§. 

Hydrargyrum Ammoniatum (Ammoniated Mercury) (NH 2 HgCl). 
This preparation, commonly called white precipitate, is made by pre- 
cipitating a solution of corrosive sublimate by ammonia-water; 
ammonium chloride is formed in solution, and ammoniated mercury 
is thrown down. It is considered to be mercuric ammonium chloride. 
It is a perfectly white powder, insoluble in water and alcohol, de- 
composed by boiling water, inodorous, and has an earthy, afterward 
metallic, taste. It is largely adulterated, chiefly with calcium sul- 
phate. 

Incompatibles. — -It cannot be mixed with iodine, bromine or 
chlorine without composition. 

Toxicology. — Its effects are poisonous. Grahamf reports an 
instance of non-fatal poisoning in a man who, having swallowed 5ij , 
was seized with vomiting and bloody diarrhoea, but no salivation 
nor sponginess of the gums occurred. 

Medical Uses. — It is used only as an external application, as 
a powder or in the form of ointment (unguentum hydrargyri 
a7nmoniati, 10 parts of ammoniated mercury to 90 parts of ben- 
zoinated lard), to cutaneous eruptions, as phthiriasis, and to destroy 
pedicu/i and the tinea of ring-worm. 

Hydrargyri Subsulphas Flavus (Yellow' Mercurial Subsuphate) 
(Hg(Hgo) 2 S0 4 ). This salt, commonly called turpeth mineral, from 
its resemblance to the root of Ipomcea turpethum, is made by throw- 
ing mercuric sulphate (as obtained from the action of sulphuric and 
nitric acids on mercury) into boiling water ; the mercuric sulphate 
is instantly decomposed into a soluble acid salt and the insoluble 
yellow subsulphate — turpeth mineral — which is precipitated. It is 

* " A Treatise on Poisons," 4th ed., p. 427. f Brit. Med. Journ., 1869, p. 329. 



ALTERA TIVES—PREPARA TIONS OF MERCUR Y. 443 

an inodorous, lemon-yellow powder, entirely dissipated by heat, of 
a rather acrid taste, and sparingly soluble in water. 

Toxicology. — In an overdose it is poisonous,* gr. xl having 
proved fatal to a man, the chief symptoms being violent vomiting 
and purging. 

Effects and Uses. — It has been employed as an alterative, in 
doses of gr. %-]4 • as an emetic, in croap it is highly recommended 
in doses of gr. ij-v in syrup or honey, repeated in fifteen minutes if 
there has not been decided vomiting, and given throughout the at- 
tack whenever the breathing becomes suffocative from accumulations 
of mucus. It produces free vomiting without effort or subsequent 
depression. 

Hydrargyri Sulphidum Rubrum (Red Mercurial Sulphide) (Mer- 
curic Sulphide) (HgS), or cinnabar (which is found as a native com- 
bination), is manufactured by subliming a mixture of one part of 
sublimed sulphur and five parts of mercury. It occurs in the 
form of heavy, brilliant, deep-red, crystalline masses, which are 
inodorous, tasteless, entirely volatilizable by heat, and insoluble in 
water and alcohol. It is not employed internally, but is used in the way 
of fumigation, in venereal idcers of the throat and nose; 5ss may be 
thrown on a red-hot iron and inhaled. It is but seldom prescribed. 
Cinnabar is used as a paint under the name of vermilion. 

Unguentum Hydrargyri Nitratis (Ointment of Mercurial Nitrate). 
Mercurial Nitrate is employed chiefly in the form of ointment. 
This preparation, known as citrine ointment, is made by dissolving 
7 parts of mercury in 10 parts of nitric acid and adding the solu- 
tion to a mixture of nitric acid 7 parts, with lard-oil 76 parts, pre- 
viously melted at 15 8°, and stirring until effervescence ceases. The 
chemical changes which result here are not precisely known ; but 
mercuric nitrate (2(Hg2N0 3 ).H 2 0) is probably formed, with fatty 
acids and ela'idin. Citrine ointment has a fine yellow color and 
an unctous consistence ; but if not very carefully made, it becomes 
greenish, hard and friable. 

Medicinal Uses. — It is an excellent stimulant and alterative 
application, much employed in porrigo, psoriasis, impetigo, pruritus 
ani, and in a wide range of ulcerated and eruptive affections, rupia 
and acne for example. It is best to dilute it, at first, with lard. 

Liquor Hydrargyri Nitratis (Solution of Mercurial Nitrate} (Mer- 

* '* Med. Jurisprudence," Taylor, 1865, p. 233. 



444 MATERIA MEDICA AND THERAPEUTICS. 

curie Nitrate) (Hg2N0 3 ) is prepared by dissolving red mercuric 
oxide (40 parts) in a mixture of nitric acid (45 parts) with distilled 
water (15 parts). It is a dense, transparent, nearly colorless liquid 
(sp. gr. 2.100), of a strongly acid taste, containing about 50 per cent, 
of mercuric nitrate in solution with some free nitric acid, and is em- 
ployed as a caustic application in hospital gangrene, lupus, venereal 
and malignant ulcers, and, diluted, in cutaneous affections. Diluted 
with 12 parts of water it forms a useful application to mucous patches. 
Toxicology. — A teaspoonful of mercury * dissolved in strong 
nitric acid killed a lad aged sixteen, in two and a half hours, the 
symptoms being abdominal pain, purging and vomiting. 

AURI ET SODII CHLORIDUM AURIC AND SODIUM CHLORIDE. 

Auric and sodium chloride is a mixture of equal parts of these 
salts (AuCl 3 NaC1.2H 2 0). It is an orange-colored salt, without smell 
but having a nauseous metallic taste. It is soluble in alcohol; more 
so in water. 

Physiological Effects. — Locally it is a caustic. Internally it is 
a stimulant to the nervous system, especially to the spinal cord. It 
acts like the mercurials on the blood, reducing the oxidizing power 
of the red globules (Farquharson). It stimulates the glandular se- 
cretion and increases the secretion of urine and of perspiration. 
Salivation, without tendency to ulceration, sometimes succeeds its 
prolonged use, but it is less apt to occur after the use of this salt 
than after the other salts of gold. f In large doses it causes violent 
gastro-enteritis. It stimulates the sexual organs and is said to in^ 
crease the catamenia. Large quantities induce symptoms analo- 
gous to those of poisoning by mercuric chloride. The same treat- 
ment is indicated. 

Medicinal Uses. — This salt is used chiefly as an alterative in 
chronic cases of tertiary syphilis and in scrofula. It is also recom- 
mended in nervous dyspepsia, duodenal catarrh, etc. In the chronic 
forms of Bright 's disease, granular and fibroid kidney, improvement 
sometimes follows the use of small doses of this remedy, and in 
functional impotence it is not without value. Dose, gr. ^5— rff- It is 
best given in pill or wafer. 



* London Med. Gazette, vii, p. 339. 

f Schmid's Jahrb,, June, 1870. Martin. 



AL TERA TIVES— IODINE. 445 

IODUM-IODINE. 

Iodine (I) is an elementary, non-metallic substance, found in the 
vegetable, animal and mineral kingdoms of nature, as in marine 
plants, oysters, sponges, mineral springs, etc. It is chiefly manu- 
factured from the residuum of kelp (the impure soda obtained from 
the incineration of sea-weeds), in which it exists as a sodium iodide, 
by the action of sulphuric acid and manganese dioxide. 

Chemistry and Tests. — It occurs in crystalline scales, of a 
bluish-black color and metallic lustre, of a strong, peculiar odor and 
a hot, acrid taste. It is very volatile, evaporating even at common 
temperatures ; is freely soluble in glycerin, alcohol and ether, and 
but very slightly soluble in water (i part in 7000 parts of water). 
Its solubility in water is very much increased by the addition of cer- 
tain salts, as the potassium iodide, sodium chloride, etc. When 
heated its vapor has a rich violet color, whence its name (from uodr^ } 
violet). Tests. — Iodine may be detected in very minute quantity by 
decoction of starch, which produces with it a combination of a 
deep-blue color, termed " iodide of starch"; if combined, the iodine 
must be first freed with a little nitric acid, or still better with chromic 
acid. A solution of iodine in chloroform should be perfectly clear. 

Incompatibles. — With the alkaloids, and most of the metallic 
salts, iodides are produced. Given in aqueous solution the iodine is 
precipitated; potassium iodide promotes its solubility in water. 

Aids. — Carbolic acid and the mercurials. 

Physiological Effects. — Iodine is an antiseptic, antizymotic 
and protoplasmic poison, killing the lower forms of animal and 
vegetable life. It acts locally as an irritant ; when applied to the 
epidermis it stains it yellow, and causes itching, redness and des- 
quamation ; and when inhaled in the form of vapor, it excites 
irritation in the air-passages. Internally, in medicinal doses, it pro- 
duces a sensation of heat and burning in the stomach, and soon irri- 
tates that organ. It is readily absorbed by the mucous membranes 
generally, and is found in the blood chiefly in combination with 
sodium; after absorption it produces a remedial alterative effect, 
without any obvious disturbance of the functions. In a physiologi- 
cal condition patients become thin under its use, though when iodine 
or the iodides are are administered in syphilis, their alterative action 
on the nutrition produces embonpoint, due to the elimination of the 
syphilitic poison which has depressed nutrition, and the consequent 



446 MATERIA MEDICA AND THERAPEUTICS. 

reaction of the system. It excites the secretions generally, increas- 
ing the flow of urine, slightly relaxing the bowels, often producing 
a marked irritant effect on the respiratory mucous membrane and 
salivary glands, and is readily and rapidly eliminated from the 
blood, in the urine and saliva (See*), and by the mucous membranes 
generally. If administered in too large doses, or to persons of ir- 
ritable stomach, or to individuals susceptible to its action, it gives 
rise to subacute gastro-enteritis; and when continued for a long 
time it will produce gastro-enteric symptoms — headache, giddiness 
and other evidence of cerebro-spinal disturbance — marasmus — 
sometimes discoloration of the skin — or various cutaneous eruptions 
as acne — occasionally salivation — and frequently a wasting of the 
mammce and testicles. This train of symptoms is termed iodism. 

Toxicology and Antidotes. — In excessive doses it may act as 
an irritant poison, and has even produced death ; but such a result 
is rare. In the case of a woman f 5j in spirit f Sj proved fatal, the 
chief symptoms being violent pain in the throat and stomach. Cul- 
peperj reports a fatal case of poisoning from the application of a 
preparation of iodine (5ij) to the entire surface of the legs of a 
child aged eleven. The symptoms were vomiting, purging (dysen- 
teric), pain in the head and stomach, hiccough, and suppression of 
urine. Large quantities have, however, been taken with slight 
effects (5iiss). The antidote is starch, which may be taken in the 
form of flour arrow-root or ordinary starch-water. The stomach 
should first be evacuated. 

Medicinal Uses. — Iodine has been used with success in some 
cases of vomiting of pregnancy ; a few drops of the tincture may be 
given for this purpose. It is a most valuable resolvent remedy 
in chronic visceral and glandidar enlargements, indurations, thicken- 
ing of membranes, tumors, etc. It is employed in goitre and scro- 
fula ; also as an alterative in the late secondary and in the tertiary 
manifestations of syphilis when the iodides are not tolerated, and in 
other chronic affections. It is highly recommended by the Ger- 
mans in the treatment of typhoid fever, reducing the temperature 
and restraining diarrhoea; the compound solution or tincture may be 
given, largely diluted. The administration of iodine is advised by 



* London Med. Record, 1873, p. 777. 

f Provincial Med. and Surg: Journ., 1847, p. 356. 

% Therap. Gaz., April, 1888, p. 225. 



AL TERA TIVES— IODINE. 447 

many practitioners in malarial fevers ', and, while it is admitted that it 
cannot compete with quinine in these diseases, it is said that, gene- 
rally, it promptly arrests the attack.* The compound tincture should 
be given in doses of Tftx-xv thrice daily (Dr. Anderson, quoted by 
Ringer). The vapor given off by volatilizing the tincture by hot 
water in a wide-mouthed bottle has been inhaled with benefit in 
chrome bronchitis, phthisis, obstinate sneezing, and in the coryza of 
hay-fever, influenza, and acnte nasal catarrh. 

It is a valuable topical remedy, and is applied in the form of 
tincture, with the greatest advantage, to enlarged glands (especially 
when scrofulous), erysipelas, boils, carbuncles, in the forming stage of 
abscess, adenitis, and bubo, in endometritis applied within the uterus 
upon a probe armed with cotton, to prevent pitting in smallpox, as 
a counter-irritant to the chest in phthisis, chronic bronchitis, and pleu- 
risy to the larynx in acute and chronic laryngitis, and hoarseness, and 
in chronic thickenings and exudations, around the joints, due to rheu- 
matism, synovitis or injuries, and to promote the absorption of 
fluid in diseases of the bursa. Iodine topically is contraindicated 
when suppuration is about to take place as indicated by a hot, tense, 
inflamed condition of the parts. The time then has arrived for 
soothing emollient applications. As a counter-irritant, six coats 
should be applied to the part, morning and evening, with a camel's- 
hair pencil, and each coat allowed to become dry before the suc- 
ceeding one is laid on — to be discontinued when desquamation 
occurs. It is more suitable to chronic than acute affections. As 
an injection in hydrocele, it has been used with benefit. After the 
evacuation of the sac, f3ss-j is introduced, and the pain may be 
diminished by the previous injection of TTlxx or more of a solution 
of cocaine (4 per cent.). Dr. S. W. Gross f has collected 540 cases 
of hydrocele treated with iodine in which there were no deaths, re- 
currence in 8.15, and suppuration or gangrene in 1.66 per cent. 
In chronic pleurisy with effusion after aspiration, it has even been 
injected into the pleural cavity. It is occasionally resorted to as 
an injection in spina bifida. In cystic goitre Dr. A. Worner, of Tu- 
bingen, recommends the injection of pure tincture of iodine after 
puncture and withdrawal of the fluid. It may also be used with 

* Am. Jour n. Med. Set., April, I883. Drs. Atkinson and Woods, of Baltimore. N. F. 
Snejkoff {Meditz Oboz., Fasc. xxiii, 1884, p. 1042), obtained no effect from iodine in two- 
thirds of their cases of malarial fevers. 

■\ Med. Times. April, 1888, p. 384. 



44S MATERIA MEDIC A AND THERAPEUTICS. 

excellent effect in hypertrophied tonsils and glandular tumors. The 
tincture should be deeply injected into the part, and care must be 
taken not to throw the injection into a vessel. Prof. Richet * highly 
recommends the hypodermic injection of the tincture in cases of 
malignant pustule, and Beverly Robinson,f following the treatment 
of Prof. William Pepper, has successfully injected from 1Tlv-io of 
Lugol's solution, diluted with 15 parts of distilled water, mto phthi- 
sical cavities. The injection should be made either high up in the 
axillary region, in the 1st, 2d, or 3d intercostal space, or anteriorly 
in the 1st, 2d, or 3d, intercostal space, on or to the outside of the 
line of the nipple. Iodine ranks also among the best of the disin- 
fectants, being available from the ease of its application as well as its 
ready portability. 

Administration. — Iodine is rarely exhibited alone, but usually 
in conjunction with potassium iodide (q. v.). To avoid gastric 
irritation, it is best given after a meal, particularly when amy- 
laceous substances have been taken, as it forms with them 
iodized starch. Dose, gr.}(-}4 two or three times daily. Liquor 
iodi compositus — compound solution of iodine — sometimes known as 
Lugol's Solution (iodine 5 parts, potassium iodide 10 parts, distilled 
water 85 parts), is the usual preparation in which iodine is adminis- 
tered internally, dose, Tftv-xv three times a day, in sweetened water 
and gradually increased. The tincture (tinctura iodi) (8 parts to 
alcohol 92 parts) is of a deep-brown color, and undergoes a gradual 
change when kept long ; water precipitates the iodine from it, hence 
it is little employed internally ; dose, gtt. x-xx, repeated and in- 
creased. Externally the tincture is extensively applied to erysipela- 
tous and poisoned parts, chilblain and parasitic affections, as tinea cir- 
cinata, versicolor, and capitis. Stains of the tincture may be removed 
from the skin by aqua ammonise; from linen by sodium hyposulphite 
in solution. The compound tincture (iodine §ss, potassium iodide Sj, 
alcohol Oj is not official, but has the advantage over the tincture 
that it may be diluted with water without decomposition, dose, gtt. 
xv-xxx. Iodine ointment (iinguentum iodi) (made with iodine 4 
parts, potassium iodide 1 part, water 2 parts, and benzoinated lard 
93 parts) is employed as a local application in goitre, scrofulous 
tumefactions, etc., and frequently as a substitute for the tincture. 
Iodine baths have been employed, with iodine and potassium iodide 

* Rev. des. Sci. Med., Avril 2 iieme, 1883. f N. Y. Med. Rec, Jan. ioth, 1885. 



ALTERATIVES— POTASSIUM IODIDE. 449 

dissolved in water, in a wooden bath-tub, in the proportion of iodine 
gr. iij and potassium iodide gr. vj to a gallon of water. By this 
method the systemic effects of iodine are obtained. 

POTASSII IODIDUM— POTASSIUM IODIDE. 

Preparation and Description.— This salt is prepared by 
treating an aqueous solution of potassa with iodine in slight excess. 
By this process a mixture of potassium iodide and potassium iodate 
is obtained, and the iodide is afterward deoxidized and converted 
into iodide by heat and mixture with powdered charcoal. Potas- 
sium iodide (KI) occurs in semi-opaque, white or transparent anhy- 
drous crystals, permanent in a dry air, rather deliquescent in a 
moist one, of an acrid, saline taste, somewhat like that of common 
salt. It is wholly soluble in water and alcohol, and its aqueous 
solution dissolves iodine, forming ioduretted potassium iodide. It is 
frequently adulterated with other salts. 

Incompatibles. — With acids and acid salts, spt. nitrous ether, 
the soluble lead salts and the mercurials generally, silver nitrate and 
the alkaloids; with potassium chlorate, if a mineral acid be added, 
a poisonous potassium iodate is produced. 

Aids. — The mercurials. 

Physiological Effects. — The effects of potassium iodide are 
analogous to those of iodine, but less energetic. Locally, it acts as an 
irritant. Internally : when given by the stomach on account of its 
ready diffusibility, it is soon taken up by the blood and can shortly 
be tasted in the saliva. In large doses it sometimes occasions nau- 
sea, vomiting, heat of stomach, and purging ; but it may be given 
in larger doses, and for a longer period, than iodine without causing 
gastro-enteric derangement. Pelikan in 1856 denied that the iodides 
of the alkalies irritate the gastro-intestinal mucous membrane, 
and this has recently been affirmed by Dr. A. Smirnoff, (loc. cit.). 
Under its prolonged use, the digestive function of the gastric juice 
fails, although the quantity secreted remains unaltered (A. Smir- 
noff*). It stimulates the secretions, particularly those from mucous 
membranes, and very often produces coryza. During a course of 
iodide treatment acneiform eruptions are likely to break out. 
Potassium iodide decidedly lessens the secretion of milk, and as 
it disturbs the functions of the glands the relative quantity of the 

* ". Inaug. Dissertation," St. Petersburg, 1884. 
29 



450 MATERIA MEDICA AND THERAPEUTICS. 

different ingredients fluctuates. Iodine appears in the milk very 
soon after the first dose of the salt is taken, and disappears as soon 
as the drug is stopped. It is found in combination with the casein 
of the milk, but the amount present bears no constant relation to 
the amount of the salt administered (Dr. Max Stumpf*). According 
to Trasbot potassium iodide produces acceleration of the pulse and 
vascular dilatation, which leads to an abundant glandular secretion. 
Its constitutional effects are powerfully alterative and resolvent, 
as it increases the disintegration and elimination of albuminous 
compounds, thus causing wasting and emaciation when admin- 
istered in health ; but like iodine, it acts most readily on morbid 
products. It is eliminated by the mucous membranes generally, but 
chiefly by the kidneys acting as a diuretic and increasing the amount 
of water, urea, uric, phosphoric and sulphuric acids in the urine. 

Medicinal Uses. — It is employed in goitre and scrofula; in 
tertiary syphilis (in which it is usually combined with or followed 
by some mercurial preparation), and other chronic diseases, accom- 
panied with enlargements or exudations as of the Joints. It is a most 
valuable antisyphilitic remedy when the bones and fibrous tissues 
and true skin are affected, as in cartes, periostitis and rupia. In all 
affections of syphilitic origin, nervous or otherwise, as syphilitic 
neuralgia, amaurosis, keratitis, ox paraplegia, large doses of the salt 
give prompt relief, and in gummata of the brain and other parts 
they are of signal advantage. It has been given hypodermically 
when it disorders the indigestion. In chronic rheumatism, gonor- 
rhceal rheumatism, and gout, particularly where the fibrous tissues 
are attacked, it is of great efficacy. It is highly recommended in 
the early stages of interstitial hepatitis (cirrhosis) before contraction 
has taken place. As a diuretic in serous effusions it has been found 
useful; and in spasmodic asthma, given between the attacks, it will 
often prevent their occurrence or increase the interval between them. 
As an eliminative antidote in mercurial and saturnine poisoning its 
action has been already noticed. It has been recommended in 
hydrocephalus, to promote absorption in the latter stage of cerebro- 
spinal meningitis, as an alterative in spinal sclerosis, and it has 
been found to exercise a beneficial influence in the treatment of 
aneurism. In deep-seated aneurism, large doses (gr. xx-xl) are 
advised by Burney Yeof who thinks these exert a favorable influ- 

* Deutsches Arch.f. kiln. Med., Jan., 1882. f Lancet, Feb., 1886. 



ALTERATIVES— POTASSIUM IODIDE. 451 

ence by diminishing cardiac action and lowering the general blood- 
pressure. Dr. H. W. Stelwagon* recommends it highly in sub- 
acute and chronic eczema, especially when arsenic has failed to ex- 
ert a favorable influence on the disease, combined with suitable 
external treatment. He gives gr. ss increased to gr. v to a child in 
syrup of orange-peel and water, or to an adnlt, gr. v-x in Hux- 
ham's tincture or compound tincture of gentian. 

Administration. — Dose, gr. v-xv to 5j or more (depending 
on the idiosyncrasy of the patient), three times a day, in aqueous 
solution, disguised with the compound syrup of sarsaparilla, simple 
elixir, or syrup of orange, but very much larger doses may be re- 
quired in tertiary syphilis. Mr. Jonathan Hutchinsonf recommends 
beginning with a small dose (gr. ij-iij) at first, increased by the 
addition of gr. ij per week, if the cure be not progressing rapidly. 
He finds a combination of ammonium, sodium and potassium 
iodides often answers better than the potassium salt alone, and that 
free ammonia or sal volatile increases the efficiency of any of the 
iodides. An ointment ( potassium iodide, 12 parts, sodium hypo- 
sulphite 1 part, benzoinated lard 8 [ parts, boiling water 6 parts), is 
employed for the same purpose as iodine ointment, and does not 
discolor the skin ; it is, however, of feebler efficacy. It is said that 
when administered in milk, not only is the unpleasant taste some- 
what disguised, but the salt is less apt to disagree with the stomach. 

Ammonii Iodidum {Ammonium Iodide) (NH 4 I) — is made by the 
double decomposition of potassium iodide and ammonium sulphate 
in hot aqueo-alcoholic solution. It occurs as a white, granular, 
very deliquescent salt, becoming yellowish-brown by exposure, but 
when deeply colored, the U. S. P. directs that il it should not be 
dispensed." It is very soluble in water and alcohol, of a taste like 
that of potassium iodide, but a little sharper. 

Medicinal Uses. — It has been similarly used as the latter salt, 
and recommended in catarrhal jaundice after the acute symptoms 
have subsided (gr. j-iij p. r. n.), and in the early stages of cirrhosis 
of the liver. It is also very useful in chronic bronchitis, capillary 
bronchitis and in pneumonia to promote the absorption of the exuda- 
tion and to prevent caseous degeneration. 

Sodii Iodidum {Sodium Iodide) (Nal) — may be made by the 
double decomposition of iron iodide and sodium carbonate. It 

* Med. News, April 2d, 1885. f " On Syphilis," 1887. 



452 MATERIA MEDIC A AND THERAPEUTICS. 

is a soluble, white, crystalline salt, used to fulfill the same indi- 
cations as potassium iodide, than which it is said to be better 
borne. 

Medicinal Uses. — Iodine is employed in medicine in various 
chemical combinations. The iron, lead and mercurial iodides have 
been noticed. Iodized starch (amylum iodidmn) has been highly 
recommended as a dressing for syphilitic ulcers, etc. Zinc iodide 
(see p. 205) is employed as a tonic and astringent. Sulphur iodide 
(sulphuris iodidum) is prepared by heating together iodine 4 parts, 
and washed sulphur, 1 part; it is a grayish-black solid substance, 
of a radiated crystalline appearance, having the smell and taste of 
iodine, decomposed upon exposure to the air and by boiling water 
and alcohol, insoluble in water, but soluble in 60 parts of glycerin; 
it is used internally in scrofulous and cutaneous affections, in doses 
of gr. J^-j, and externally in tinea capitis, lupus, lepra, acne, etc., in 
the form of ointment (gr. xxx to lard 5j). The dose of sodium 
iodide is gr. v. to xv. to 5, administered in the same way as 
the potassium iodide. 

OLEUM MORRHUiE-COD-LIVER OIL. 

This is a fixed oil obtained from the liver of Gadus Mor- 
rhua, the common cod {Class Pisces; Ord. Teleostia, Fam. Gadida) 
— a well-known fish of the northern Atlantic — and also from the 
livers of several other species of Gadus. 

Preparation. — It is prepared by subjecting the livers to heat, 
either in boilers with water or by means of steam externally applied, 
and afterward draining off the liquid portion, from which the oil 
separates on standing. It is said to be sometimes procured also by 
expression. Three varieties are known, the white ox pale-yellow, the 
brownish-yellow , and the dark-brown. They differ chiefly in the 
mode of preparation — the pale being prepared from fresh livers, the 
dark-brown from those which are collected at sea and have under- 
gone putrefactive decomposition, and the brownish-yellow from those 
in which putrefaction has only partially commenced. The pale oil 
is the purest ; the dark oil is the most offensive to the taste and 
smell, and the least acceptable to the stomach. 

Chemical Constituents. — Cod-liver oil is of the consistence 
of lamp-oil, and has a peculiar odor, resembling that of shoe-leather 
— which is usually prepared in the United States with this oil — and 
a fishy-acrid taste. These sensible properties are probably the best 



ALTERATIVES— COD-LIVER OIL. 453 

tests of the oil, and it should be rejected if the smell and taste of 
shoe-leather are wanting, or if those of lamp-oil or fish-oil are very- 
perceptible. The sp. gr. of the best oil is about 0.920-0.925. The 
oil undergoes a gradual change from exposure to the air, and should, 
therefore, be kept in full and well-stoppered bottles. It is insoluble 
in glycerin and water, somewhat so in alcohol, readily soluble in 
ether and chloroform. It contains a great variety of chemical con- 
stituents, the most important of which are fatty acids, several biliary 
principles, a peculiar brown substance called gaduin (which is not, 
however, supposed to be the active ingredient), iodine, chlorine, and 
traces of bromine. 

Dr. Joseph Lefage,* assisted by Dr. Chapoteaut, obtained a 
product from the oil which they named morrhuol, and which repre- 
sents the active principles of cod-liver oil. 

It is obtained (1) by treating the oil with an aqueous solution 
of sodium bicarbonate, which dissolves the acid at low temperature; 
(2) by agitating the oil with 90 per cent, of alcohol, separating it 
from the oil and submitting it (alcohol) to distillation. Morrhuol 
is acrid, bitter, very aromatic and partly crystalline at ordinary 
temperatures. It contains considerable quantities of iodine, bro- 
mine and phosphorus. The oil after its removal is tasteless and 
odorless. 

Tests. — Cod-liver oil may be distinguished from other oils by 
the agency of sulphuric acid, a drop of which, when added to fresh 
cod-liver oil, on a porcelain plate, causes a centrifugal movement 
in the oil, and gives rise to a fine violet color, soon passing into 
yellowish or brownish-red. This reaction is attributable, however, 
to the bile contained in the oil. By reaction with ammonia, in dis- 
tillation, the peculiar volatile principle trimethylamine (the odorous 
principle of pickled herring) is developed. 

Physiological Effects. — Cod-liver oil, like all fats, is appro- 
priated not in the stomach, but in the small intestine where it is 
emulsified by the pancreatic juice and bile forming the molecular 
base of the chyle. Being colloidal and therefore not in a state to 
osmose easily its passage through the intestinal walls into the 
portal blood is facilitated by the bile. Its prolonged use, in doses 
which allow it to be retained by the digestive tube, produce very 
marked beneficial effects in a wfde range of chronic diseases de- 

* Der Fortschrltt, Feb. 20th, 1886, from Le Bull, de Therap. and Le Bull. Com. 



454 MATERIA MEDICA AND THERAPEUTICS. 

pendent on a vitiated condition of the functions of digestion, assimi- 
lation and nutrition. Its modus medendi is not well understood; 
some therapeutists believing it to act merely as a nutritive agent, 
valuable from the readiness with which it is assimilated; others 
attributing its curative powers to an alterative action from the iodine 
and bromine or other principles which it contains. Its effects are, 
however, probably due merely to its nutrient action, in supplying a 
sufficiency of molecular base for interstitial growth. The biliary 
principles which it contains promote its absorption and appropria- 
tion by the system. The most striking feature of its action on the 
economy is increase of weight ; and usually, where it fails to increase 
the weight, it is of little service. It is believed, also, to diminish 
the formation of uric acid in the system, and hence may be useful 
in gout. In large doses, cod-liver oil produces nausea and diarrhoea, 
and these effects occasionally follow the use of medicinal doses. 

Medicinal Uses. — Cod-liver oil has long been known as a 
remedy in rheumatic diseases ; and within the last forty years it has 
come into extensive use as an alterative and nutrient in tuberculous, 
scrofulous affections, and in various cachexies. In the treatment of 
phthisis pulmonalis it is now looked upon, in Great Britain and the 
United States, as equal to or superior to any other agent, and as 
possessing an undoubted power of arresting the progress of both 
the general and the local symptoms of the disease. Although 
efficacious in all the stages of phthisis, its value is most conspicuous 
early in the disease, especially before the formation of true tubercles. 

Over the different forms of scrofula it exercises also a very de- 
cided control — particularly adenitis, ulcers, diseases of the joints and 
spine, rickets, ophthalmia, and keratitis. In the various cutaneous 
affections, tertiary syphilis, chronic rheumatism, rheumatic arthritis, 
and gout, and the entire circle of chronic disorders in which there 
is a tendency to marasmus, and where the nutrition is defective, as 
in hemiplegia, emphysema, and asthenia, cod-liver oil is employed 
with benefit. Its good effects are most conspicuous in proportion 
to the youth of the patient. 

Morrhuol is strongly recommended in the first stage of tuber- 
cidosis, in infa?itile scrofulosis and rachitis, and in chronic bronchitis* 
Dr. E. Chazeaud,f from the careful study of ten cases of pulmonary 



* Dr. Joseph Lefage, op. cit. 

f Etudes cliniques sur le morrhuol,these, par E Chazeaud, Pans, 1887. 



AL TERA TIVES—PREPARA TIONS OF ARSENIC. 455 

phthisis in which he -had administered morrhuol, concludes that it 
increases the appetite and weight, lessens or extinguishes the cough 
and with it the symptoms of debility, and diminishes the excretion 
of urea. 

Administration. — Dose f Sss two or three times a day, one 
hour after each meal ; though, if unacceptable to the stomach, it is 
best to begin with f5j doses. The addition of a little ether (gtt. 
xij-xx to foj of oil) promotes its digestion. It must be persevered 
with for a long time before its good effects appear. It is best given 
in some aromatic water, or a little ardent spirit, or the froth of 
porter; and it may be rendered more agreeable to the stomach by 
combination with one of the mineral acids. The union of the oil 
with lime-water, just enough to form a soap, often renders it ac- 
ceptable to delicate stomachs, and it may be flavored with oil of 
bitter almond. If it produce diarrhoea, astringents should be ad- 
ministered with it, or the dose should be decreased, or the oil 
stopped. It is used as a clyster in cases of ascarides and lumbri- 
coides ; and externally, as a lubricant in cutaneous affections, and in 
opacity of the cornea. 

Phosphorated cod-liver oil is made by the direct addition of 
phosphorated oil (see p. 185) to the amount of cod-liver oil re- 
quired to furnish the desired strength of phosphorus. 

Morrhuol is best given in capsules (gr. iij = gr. 80 of the oil) 
on account of its disagreeable taste and aromatic smell. 

ARSEN1I PR^PARATA— PREPARATIONS OF ARSENIC. 

Metallic arsenic is inert, though when swallowed it may prove 
powerfully poisonous by becoming oxidized and converted into 
arsenious acid. It is not used in medicine. 

Acidum Arseniosum {Arsenious Acid) (As 2 3 ), sometimes called 
white arsenic, arsenic oxide or arsenic. 

Preparation and Description. — It is obtained principally as a 
secondary product in the roasting of cobalt ores (the cobalt arsen- 
ides) in Saxony and Bohemia. It is afterward purified by sub- 
limation, and when recently prepared, occurs in glassy, colorless, 
transparent masses of a vitreous fracture, which gradually become 
white and opaque, progressively from the surface inward. It is 
kept sometimes in the shops in the form of a fine white powder ; 
but in this state it is liable to adulteration with chalk or calcium 
sulphate, and it should, therefore, be always purchased in masses. 



456 MATERIA MEDICA AND THERAPEUTICS. 

It is entirely volatilized by heat, at a temperature not exceeding 
424.4 F.; has no smell and little or no taste; is soluble in water, 
and also in alcohol and oils. Cold water dissolves from x^Voth to 
3^th part of its weight of arsenious acid, or about gr. ss-j to f3J. 
By prolonged boiling with water ^Vth part will be dissolved and 
retained in solution, or about gr. xij to f§j.* 

Tests. — Owing to the frequent use of arsenious acid as a 
poison, a knowledge of the means of detecting its presence is of 
great importance. In the solid state it may be recognized in the 
first place by its volatility (heated over a spirit-lamp, it passes off as 
a white, inodorous vapor, and is deposited on a cool surface as an 
amorphous powder or in octahedral crystals): secondly, when 
thrown on burning charcoal it is deoxidized, and gives out the 
garlicky odor of metallic arsenic (other substances give off a similar 
odor); and thirdly, if heated in a glass-tube with charcoal or black 
flux, it sublimes and condenses in the form of a brilliant steel-gray 
ring or mirror, soluble in sodium or calcium hypochlorite. In 
aqueous solution arsenious acid may be detected by the following 
reagents : sidphtiretted hydrogen or ammonium sulphide produce a 
lemon or sulphur-yellow arsenic trisulphide, which may be distin- 
guished from the antimonial and stannic sulphides by being solu- 
ble in a solution of ammonium carbonate and insoluble in diluted 
hydrochloric acid ; the addition first of ammonia and then of silver 
nitrate produces a canary -ye How silver arsenite; and the addition 
of ammonia and then of cupric sulphate produces an apple or grass- 
green cupric arsenite; gr. 100 boiled with diluted hydrochloric acid, 
and then treated 'with sulphuretted hydrogen, yield, a deposit of 
arsenic trisulphide weighing gr. 124. The arsenic trisulphide may 
be reduced and made to yield metallic arsenic, if heated with soda 
flux or potash flux. 

A very delicate test for arsenious acid in solution is that of 
nascent hydrogen termed Marsh's test. When the acid is submitted 
to the action of nascent hydrogen (evolved by the action of diluted 
sulphuric acid on pure zinc), it is deoxidized, and unites with the 
hydrogen to form arseniuretted hydrogen gas. This gas has a 
garlicky odor, and is recognized by its burning with a bluish-white 
flame which deposits on a plate of cold glass or porcelain, held over 



* " Med. Jurisprudence and Toxicology," 1884, p. 239, Reese ; also Taylor's " Med. 
Jurisprudence," 7th Am. ed., p. 140. 



ALTERATIVES— PREPARATIONS OF ARSENIC. 457 

the jet, a lustrous steel-gray or brownish black spot or mirror of 
metallic arsenic, surrounded by a faint white ring of arsenious acid; 
the metallic spot deposited is distinguishable from antimony, ob- 
tained by a similar process, by the addition of a drop or two of fuming 
nitric acid, with heat, which dissolves both metals, the solutions 
yielding on evaporation white residues, but the arsenical residue, 
touched with a drop of strong solution of silver nitrate, assumes a 
brick-red color, while the antimonial residue remains unchanged; 
and also the arsenic can be dissolved by a solution of sodium or 
calcium hypochlorite, which does not affect antimony. 

Another test is that of Reinsch, which consists in boiling a solu- 
tion of the acid with hydrochloric acid and copper-foil or wire, when 
the latter acquires a steel-gray coating of metallic arsenic, passing, 
as it increases, into black. Other metals, as mercury and antimony, 
are deposited on copper under similar treatment, so that additional 
tests will have to be made to prove their absence. 

The Berzelius-Marsh test consists in the decomposition of 
arseniuretted hydrogen gas in the reduction tube (of a Marsh-ap- 
paratus) by heat, with the production of a metallic deposit before 
the flame is reached. It is now considered to be the most delicate 
of all the tests. 

When arsenious acid is dissolved with liquid organic substances, 
it should first be separated from insoluble matters by filtration, and 
the metallic arsenic may be then obtained by Reinsch 's process, and 
the liquid or subliming tests afterward applied. If the poison be 
mixed with solid organic substances, they should be cut up and 
boiled with water acidulated with hydrochloric acid, and the solution 
afterward filtered and again boiled, etc. 

Incompatibles. — With the salts of silver, copper, ammonia, 
lime-water, iron and the vegetable astringents. 

Aids. — Quinine, iron, nux vomica. 

t Physiological Effects. — Arsenious acid acts locally as an 
escharotic by destroying the vitality of the parts to which it is ap- 
plied. In medicinal doses it stimulates the digestive and nutritive 
functions, as is shown by the well-known results of arsenic-eating 
among the peasantry of Austria. Ringer and Murrell's* experi- 
ments upon frogs show that arsenic is poisonous to all nitrogenous 
tissues, but that it takes some time for it to destroy the conductivity 

* Journ. of Physiol., 1878-9, p. 213. 



458 MATERIA MEDICA AND THERAPEUTICS. 

of the motor-nerves and the muscular irritability. Their experi- 
ments differ from those of Sklarek * in respect to sensation and 
reflex action, for they found that the afferent nerves retained their 
conductive power, while Sklarek states that sensation and reflex 
action are abolished in ten minutes. The paralysis finally produced 
by arsenic is centric, with which statement all observers agree. 

The physiological effects of arsenic are not, at first, very 
obvious. When continued for some time, it usually produces more 
or less heat and dryness of the throat and stomach, with n&usea, 
increased secretion from the bowels and kidneys, irritation of the 
conjunctival and nasal mucous membranes, and a peculiar swelling 
of the face termed oedema arsenicalis ; after the latter symptom 
appears, the medicine should be suspended. No matter how ad- 
ministered, or by what channel it enters the system, arsenic shows 
a marked selective affinity for the gastro-intestinal and mucous 
tracts. The absorption f of arsenious acid into the system, after its 
administration, is shown by its presence in the blood, viscera, bile, 
urine, sweat, the buccal, bronchial and intestinal mucous mem- 
branes, and after the ingestion of large doses, a considerable amount 
is found in the liver (Lolliot J). According to Rabuteau §, arsenic 
diminishes the excretion of urea, but other observers have not con- 
firmed this statement. 

Recently arsenic has been found to be deposited in the nervous 
system : thus, if in fresh muscle I part is found, the proportion in 
liver is 10.8; in brain, 36.5 ; in the spinal cord, 37.3 (Scolosuboff||). 
Injected into the blood in mammals it causes an enormous sinking 
of the blood-pressure with slowing of the pulse rate (Unterbergerf). 
Small doses of arsenic increase the cardiac action and the activity 
of the capillary circulation ; large doses cause palpitation, a small, 
quick and irregular pulse, with flushed face and cold extremities ; 
poisonous doses depress the circulation and (in the lower animals) 
paralyze the heart in diastole. Arsenic, if too long continued 
or given in an excessive dose, decreases the number of globules 
in the blood, decomposes the hemoglobin and renders it less 



* Arch, fur Anat. u. Physiol., 1866, p. 481. 

f Arch. Gen. de Med., t. IV, 6ieme ser., p. 173; Bergeon et Lemaitre. 

\ Bull. Gen. de Therap., LXXV, p. 358. 

\ Gaz. Hebdom., V, p. 705. 

|| " Compte Rendus des Seances," II, 6ieme ser., p. 304. 

^[ Arch, fur exper. Pathol, u. Pharmakol., II, p. 89. 



AL PER A TIVES—PREPARA TIONS OF ARSENIC. 459 

coagulable (Brodie, quoted by Phillips). Small doses stimulate, 
while larger doses depress, both the respiratory centre and the. 
pulmonary end-organs of the pneumogastric. At first the urine is 
increased, but if the drug be continued it is diminished, and may be 
bloody or albuminous (Kossel*). In too long-continued or too large 
medicinal doses ; arsenious acid sometimes produces a kind of chronic 
poisoning, characterized by disorders of the digestive apparatus, 
conjunctivitis, oedema of the face, but more especially of the eyelids, 
salivation, a cutaneous eruption, pigmentationf, loss of the hair and 
nails, paralysis, convulsions, and, if its use be persevered in, coma 
and delirium may result, terminating in death. 

P. J. Hutchinson maintains that he has seen cutaneous cancer 
produced by arsenic. A temporary bronzing of the skin has been 
noticed in some cases. 

It is rapidly eliminated by the urine, and also by the bile, and 
even the skin, tears and saliva. The milk of nursing women to 
whom it has been administered also contains arsenic (Brouardel, 
Pouchet). After it has ceased to appear in the excretions the ad- 
ministration of potassium iodide will cause it to reappear, showing 
that a part of it remains deposited in the tissues. 

Toxicology. — In excessive doses arsenious acid is a violent 
poison, usually destroying life by gastro-enteritis, in from one to 
two or three days. Three fatal cases of arsenical poisoning have, 
however, been recently reported, in which no gastro-intestinal in- 
flammation was found (J. Stewart J). When very large quantities 
are taken, it sometimes acts on the cerebro-spinal system, produc- 
ing death by narcotism in a few hours. Occasionally both gastro- 
enteric and cerebro-spinal symptoms occur. Pain and diarrhoea are 
not infrequently absent, as in the cases reported by Taylor (loc. cit). 

Two grains of arsenious acid have proved fatal, though much 
larger amounts have been taken with impunity, as in the case of a 
woman § who swallowed 3ij, and who recovered after being vomited 
with tartarized antimony. Very large quantities often cause emesis, 
which removes the poison from the stomach. M. Brouardel || re- 
cords a case of death of a nursing infant, following symptoms of 



* Arch. fur. exper. Pathol, u. Pharmak., 1878-9, p. 213. 
f N. Y. Med. Record, April 12, 1890, Wehlau. 
\ Med. News, March 17th, 1888, p. 304. 
§ Guy's Hosp. Rep., 1851, p. 203 ; Taylor. 
|| "Societe de Med. Legale," 1885. 



460 MATERIA MEDICA AND THERAPEUTICS. 

arsenical poisoning in its wet nurse, who, however, recovered. He 
considers it dangerous to administer arsenic to wet nurses, as the 
lacteal secretion is active in eliminating it. 

Dissections in cases of poisoning from arsenic reveal redness 
(sometimes accompanied with extravasations of blood), ulceration, 
softening, effusion of lymph, and even gangrene, in the alimentary 
canal. Congestions of the broncho-pulmonary mucous membrane 
and of the lungs themselves are often observed, and acute fatty de- 
generation of the liver, spleen, kidneys, etc., is often seen, even when 
the poisoning has existed for a few hours only. The blood is often 
fluid and dark-colored. It has been shown experimentally that 
arsenic in solution injected into the mouth, rectum or vagina after 
death will diffuse itself through the body and may be found in the 
liver, lungs, kidneys, and even in the brain — a point of great import- 
ance in legal medicine.* 

Antidotes and Treatment in Cases of Poisoning. — The 
evacuation of the contents of the stomach by emetics or by the 
stomach-pump, if seen very soon after swallowing the poison, should 
be the first object in these cases. Demulcent drinks are to be also 
freely given. The ferric hydrate {Ferri Oxidum Hydratum) 
should be administered, as soon as it can be procured, in the state 
of pulp or magma. It is prepared by the action of an alkaline solu- 
tion on a ferric salt. Ammonia water is directed by the U. S. P. to 
be added to the solution of ferric iron (see p. 167). The ferric 
hydrate is a soft, moist, reddish-brown magma, which acts as an 
antidote to arsenious acid by forming with it an insoluble, inert fer- 
rous arseniate (Fe 2 AsOJ. The dose is about twelve times the sup- 
posed amount of poison taken, and it should be given in the fresk 
and pulpy state, as it gradually loses its antidotal virtues when 
kept. The ferric hydrate with magnesia {Ferri Oxidum Hydra- 
tum cum Magnesia) is also directed to be kept in the shops as an 
antidote to arsenic. It should be administered in the same manner 
as ferric hydrate, and possesses the advantage of a tendency to act 
on the bowels. 

Dialyzed Iron is also an antidote to arsenic in the stomach. 
To insure its conversion into ferric hydrate, its ingestion should be 
followed by the administration of a tablespoonful of sodium chloride. 
Light magnesia (which has not been too strongly calcined) and 

* Journ. Amer. Med. Associate Aug. 4th, 1883. 



ALTERATIVES— PREPARATIONS OF ARSENIC. 461 

freshly-precipitated gelatinous magnesia may be also used as anti- 
dotes. The after-treatment consists in the use of demulcents, 
opiates, and, if necessary, stimulants. 

Medicinal Uses. — Arsenious acid is a very valuable alterative 
remedy, but it must be exhibited with caution. It is employed with 
the greatest success in the treatment of chronic malarial affections, 
as dumb-ague, especially such cases as have resisted the use of 
cinchona, or have frequently re-appeared. For this purpose it 
should be given in the dose of gr. ^-12 in pill thrice daily, after 
meals, and the quantity gradually pushed until some evidence of its 
effects is obtained. When the point of toleration is reached, the 
size of the dose can be regulated so that the medicine may be safely 
taken for a considerable period. 

In chronic cutaneous affections, particularly the scaly diseases, 
lepra, eczema squamosum, psoriasis and phthiriasis, it is highly useful, 
but it should not be given while any acute inflammatory symptoms 
are present, or where there is much itching, burning, or heat of 
skin, as under these circumstances it is apt to increase the affection. 
Pemphigus is often benefited and sometimes cured by the judicious 
administration of the arsenical preparations, as are also certain cases 
of acne, especially when occurring on the face and characterized by 
numerous, finely papular lesions. A course of arsenic, too, is 
indicated in the herpes. that attacks the oral cavity in the form 
of cankers. It is also frequently beneficial in chronic eczema and 
lichen. As arsenic exerts its influence on the rete mucosum par- 
ticularly, it is more efficacious when the superficial layers of the 
skin only are involved. 

It is prescribed also in certain affections of the nervous system 
chorea in particular, over which it exercises a marked control ; in 
yieuralgia it is often of great value, especially when combined with 
iron and quinine ; in angina pectoris during the attack, Fowler's 
solution, TTlv-x, after meals, t. d., is often serviceable ; in chronic 
rheumatism, rheumatic arthritis, in irritable dyspepsia, gastric ulcer y 
chronic diarrhoea, bronchitis, phthisis (where there js not much hectic, 
nor rapid disintegration of tissue), and as a tonic generally, espe- 
cially when anemia is present, it is often combined with iron and 
quinine : 1^ Acidi arseniosi, gr. j ; quininae sulphatis, gr. xxiv ; 
ferri sulphatis exsiccati, gr. xij ; oleo-resinae capsici, gr. iv. M. 
et ft. pil. xxiv. Sig. — One pill may be taken immediately after meals 
three times a day. 



462 MATERIA MEDIC A AND THERAPEUTICS. 

As an external application, arsenious acid has been applied to 
indolent sinuses, lupus, onychia maligna, etc., either pure or mixed 
with several parts of sulphur ; when thus used, it should be applied 
freely, as a large amount is more likely to render absorption impos- 
sible, by the rapid destruction of the tissues which it causes. A 
minute crystal of arsenic moistened with creasote on cotton will 
deaden the pain in the cavity of a carious tooth. It is an ingre- 
dient of various empirical compounds employed in the treatment 
of cancer. 

Administration.— Dose, gr. T V — T \, in pills with extract of 
gentian t. d., to be reduced when conjunctivitis appears, and sus- 
pended after the establishment of the oedema arsenicalis ; and after 
being taken a fortnight, it should always be intermitted for a day 
or two. It is less apt to occasion gastric irritability when given 
immediately after a meal. The usual and safer form of exhibiting 
this remedy is that of solution with potash. Gelatin-coated pills 
of arsenious acid may be had in the shops. 

Liquor Potassii Arsenitis {Solution of Potassium Ar senile) 
(HK 2 As0 3 ), or Fowler's Solation. This is prepared by boiling I part 
of arsenious acid and potassium bicarbonate, each, in 10 parts of 
distilled water, and when dissolved, adding 3 parts of compound 
spirit of lavender, and water enough to make the solution weigh 
100 parts ; allow the solution to stand for eight days and then filter. 
It is a transparent liquid, of an alkaline reaction, and has the color, 
taste and smell of spirit of lavender. 

Incompatibles. — It is decomposed by the reagents which act 
upon arsenic, and is incompatible with infusions and decoctions of 
cinchona. 

Medicinal Uses. — Its effects and uses are analogous to those 
of arsenious acid, though some practitioners have denied their 
therapeutic identity. The treatment in acute poisoning is the same 
as that for arsenious acid. 

Fowler's solution is administered internally in the same diseases 
in which arsenious acid is given. When arsenic is to be prescribed 
for a long time, the acid itself should be selected, but when used for 
a short period, or to produce a constitutional impression rapidly, the 
more soluble arsenical preparations are preferred (Fowler's solution, 
sodium arseniate, or its solution, etc.). The solution of potassium 
arsenite is the most available form of arsenic for administration in 
the various forms of chronic skin diseases which have already been 



ALTERATIVES— PREPARATIONS OF ARSENIC. 463 

alluded to, and maybe advantageously combined with the bitter 
wine of iron, which will often prevent the gastro-intestinal de- 
rangement which is otherwise likely to ensue. The average dose 
in these cases is Tfljj-iv, t. d., prescribed with food or directly after- 
ward, always carefully watching and guarding against the super- 
vention of toxic symptoms. 

It is a good tonic, also, in anemia, and in chlorosis especially, 
when the subject is a young girl just arriving at the age of puberty, 
where iron disorders the digestion, or where the early stage of 
tuberculosis is suspected. It is well to administer it for a week or 
more continuously, and to alternate with a less soluble form of 
arsenic. 

In irritative dyspepsia, TTL j-ij well diluted, before meals, is of great 
value. In gastric ulcer* the same treatment is recommended, com- 
bined with a milk diet and regulation of the bowels. It appears to 
lessen the amount of sugar in the urine in diabetes mellitus, and it has 
been used internally and hypodermically with varying results in the 
treatment of relapsing fever. A course of Fowler's Solution in such 
chronic affections as spinal sclerosis, hypochondriasis, lymphadenoma, 
and melancholia, when other means have failed or as an adjuvant to 
them, may prove beneficial. As a tonic it is well combined with 
syrup of calcium lacto-phosphate. 

Administration.— Dose, Tllj-x, t. d., administered in aqueous 
solution. Each fluid-drachm contains of arsenious acid, gr. t 6 q. It 
may be prescribed with tonics as tincture of nux vomica. 

Sodii Arsenias (Sodium Arseniate) (Na 2 HAs0 4 7H 2 0), is made 
by melting together arsenious acid, sodium nitrate and sodium car- 
bonate, then dissolving the fused salt in boiling water, and afterward 
crystallizing. In this process the arsenious acid is oxidized into 
arsenic acid by the nitric acid of the sodium nitrate, and then com- 
bines with the soda of both salts to form colorless, transparent, pris- 
matic crystals, slightly efflorescent; very soluble in water, of a some- 
what saline, slightly acrimonious taste. 

Medicinal Uses. — This salt is employed. to fulfill the thera- 
peutic indications of the other arsenical preparations, and has the 
advantage of a somewhat milder local action. Dose, gr. T Vi, in 
pill or disguised in water. It is prescribed sometimes externally in 
the form of baths, in chronic arthritic rheumatism and gout, 5ss-iij 
in each bath. It is generally used internally in the form of — 

* Brit. Med. Jour., 1884, p. 1203, Strahan. 



464 MATERIA MEDICA AND THERAPEUTICS. 

Liquor Sodii Arseniatis (Solution of Sodium Arseniate), made by 
dissolving I part of sodium arseniate (rendered anhydrous at a heat 
not exceeding 300 ) in 99 parts of distilled water; dose, gtt. x— xx, 
mixed with water. Cigarettes made of paper saturated with a solu- 
tion, two or three times the official strength, are smoked in asthma. 

Liquor Acidi Arseniosi (Solution of Arsenious Acid) (formerly 
called solution of arsenic chloride) is made by boiling 1 part of ar- 
senious acid with 2 parts of hydrochloric acid and 25 parts of dis- 
tilled water, until the acid is dissolved, and adding to the solution, 
when cold, water enough to make it weigh 100 parts. Dose, the 
same as that of Fowler's Solution (q. v.), than which it is thought 
to be less apt to disturb the stomach. 

Arsenii Iodidum (Arsenic Iodide) (Asl 3 ), made by rubbing 5 
parts of iodine and I part of arsenic together, is an orange-red crys- 
talline, volatilizable solid, wholly soluble in water, and has been 
used both internally and externally in skin-diseases. Dose, gr. \ t. 
d., in pill or disguised in water ; for extei'nal use, gr. iij to lard Sj. 

Liquor Arsenii et Hydrargyri Iodidi (Solution of Arsenic and Mer- 
curic Iodide). This solution, known as Donovan's Solution, is pre- 
pared by dissolving 1 part of arsenic iodide and mercuric iodide, 
each, in enough distilled water to make the solution weigh 100 
parts. It is merely an aqueous solution of the two iodides (Asl 3 
and Hgl 2 ). It has a pale-yellow color and a slightly styptic taste. 

Incompatibles. — It is incompatible with the salts of the alka- 
loids and the alkalies. 

Effects and Uses. — This is a highly valuable alterative pre- 
paration in the various forms of papular and scaly cutaneous affec- 
tions, as psoriasis and phthiriasis and in obstinate syphilis. . It was 
introduced by Mr. Donovan, of Dublin, in 1839, and has been a 
good deal employed in the United States. Dose, gtt. v to xx or 
more, t. d., given disguised in water. 

CALCII PHOSPHAS PR/ECIPITATUS— PRECIPITATED CALCIUM PHOSPHATE. 

Preparation. — This salt is made by reacting upon bone-ash 
with hydrochloric acid, which dissolves the calcium phosphate in 
the bones, and gives it up again on the addition of water of ammo- 
nia. It is a white, inodorous, tasteless, insoluble powder, some- 
times called the bone phosphate of calcium (Ca 3 2P0 4 ). 

Effects and Uses. — It is an important and valuable medicine, 
not only in diseases of deficient ossification, as ununited fractures, 



ALTERATIVES— CALCIUM HYPO PHOSPHITE. 465 

caries of the bones, rickets, etc., but in all conditions of defective 
cell-growth and malnutrition, from its undoubted influence in pro- 
moting natural cell-growth and nutrition. Thus it is employed 
(often in connection with other phosphates, as those of iron, sodium 
and potassium) in scrofula, phthisis, anemia, diarrhoea, chronic bron- 
chitis, abscesses, prolonged suppurations, and wasting diseases of 
every kind. On account of its insolubility it is apt to form intes- 
tinal concretions. 

Administration. — Dose, gr. v-x, given dusted into a little 
milk. A better (because more soluble) preparation is the syrup of 
calcium lacto-phosphate (syrupus calcii lacto-phosphatis), containing 
lactic acid, calcium phosphate, orange-flower water, sugar, hydro- 
chloric acid, ammonia water and water. An emulsion containing 
50 per cent, of cod-liver oil with syrup of the lacto-phosphate is an 
excellent preparation. Dose, f3j-iv. 

CALCII HYPOPHOSPH1S-CALCIUM HYPOPHOSPHITE. 

Preparation. — This salt is prepared by boiling phosphorus in 
a mixture of calcium hydrate in boiling water; phosphoretted 
hydrogen escapes, and calcium phosphate and hypophosphite are 
formed in the liquid, from which the insoluble phosphate and resi- 
duary lime are separated by filtration, and the hypophosphite 
(CaH 4 2P0 2 ) is afterward crystallized out in the form of white, pearly 
crystals, of a nauseous, bitter taste, soluble in six parts of water, 
and insoluble in strong alcohol. 

Incompatibles. — All the soluble phosphates and carbonates 
produce precipitates with calcium hypophosphite. The potassium 
and sodium hypophosphites are incompatible with the soluble salts 
of mercury and silver. 

Potassii Hypophosphis {Potassium Hypophosphite) (KH 2 P0 2 ) — 
is prepared by mixing solutions of hypophosphite and potassium 
carbonate. It occurs in white, opaque, confused crystalline masses, 
having a disagreeble, bitter taste, very deliquescent and very soluble 
in water and alcohol, but insoluble in ether. 

Sodii Hypophosphis (Sodium Hypophosphite) (NaH 2 P0 2 .H 2 0) 
— is prepared by mixing solutions of calcium hypophosphite and 
crystallized sodium carbonate, and crystallizes in white tables of a 
pearly lustre, very deliquescent (but less so than potassium hypo- 
phosphite), very soluble in water and alcohol, and insoluble in 
ether. 

30 



466 MATERIA MEDICA AND THERAPEUTICS. 

Medicinal Uses. — The hypophosphites have been introduced in 
the treatment of phthisis under an impression that they prove useful 
by furnishing phosphorus to the tissues. They more probably act 
by stimulating cell-growth and nutrition, and may be given to fulfill 
the same indications as the precipitated calcium phosphate. 

Administration. — Dose, gr. x-xxx t. d. The calcium hypo- 
phosphite is the most eligible salt, but they are often prescribed 
together in the form of — 

Syrupus Hypophosphitum {Syrup of Hypophosphites) consist- 
ing of calcium hypophosphite 35 parts, sodium and potassium hy- 
pophosphites each 12 parts, dissolved in water by the aid of citric 
acid 1 part, and flavored with spirit of lemon, 2 parts; of sugar 500 
parts; the whole to weigh 1000 parts. It is a good preparation to 
fulfill the indications of the hypophosphites. Dose, f3j-ij- 

Syrupus Hypophosphitum cum Ferro {Syrup of Hypophos- 
phites with Iroli) contains ferrous lactate I part, dissolved in 
syrup of hypophosphites, 99 parts. It is used for the same pur- 
poses and in the same doses as the last preparation. Ferric hypo- 
phosphites have been noticed with chalybeates (see p. 172). 

CALCII CHLORIDUM-CALCIUM CHLORIDE. 

Preparation. — This salt (CaCl 2 ) is prepared by neutralizing 
hydrochloric acid with chalk or white marble, and adding a little 
chlorinated lime and slacked lime. It is a colorless, translucent 
salt, very deliquescent, readily soluble in both water and alcohol. 
It should not be confounded with chlorinated lime, which is also 
sometimes called "chloride of calcium." 

Incompatibles. — Dilute H 2 S0 4 ammonium carbonate, sodium 
phosphate and argentic solutions. 

Medicinal Uses. — It resembles the calcium preparations 
generally in its effects, and is a very efficient remedy in all 
scrofulous affections of children, as glandular enlargements, accom- 
panied by colliquative diarrhoea, a coated tongue and fetid breath 
(Coghill*). Milk is a good vehicle in which to give it. It is also 
given with benefit in wasting diseases generally and in phthisis. 
Dose, gr. v-xx. 



* The Practitioner, XIX, p. 247. 



AL TERA TIVES— AMMONIUM CHL OR IDE. 467 



AMMONII CHLORIDUM— AMMONIUM CHLORIDE. 

Preparation and Description. — This salt, formerly termed 
ammonia muriate, and often known as sal ammoniac, is obtained 
from the gas-liquor of coal-gas works (usually by neutralizing the 
ammonia with hydrochloric acid), and also in the preparation of 
animal charcoal from bones. It is brought in the crude state from 
Calcutta, for use in the arts, and in the refined state, for medicinal 
employment, from England. It occurs in white, translucent, tough, 
fibrous, hemispherical, convex- concave cakes (NH 4 C1), about two 
inches thick, difficult to powder, inodorous, of a pungent, saline 
taste, slightly deliquescent, very soluble in water, and less so in 
alcohol. 

For medicinal use it is purified by the addition of water of am- 
monia to a solution of chloride, and occurs as a snow-white crys- 
talline powder, soluble in 2^ parts of cold and in its own weight 
of boiling water, and soluble also in alcohol. 

Incompatibles. — Solutions of caustic potash, soda or lime- 
water decompose the chloride (NH 3 ) being given off; tartaric acid 
forms with it a tartrate. The mineral acids disengage HC1 ; with 
the soluble lead and silver salts chlorides are formed. 

Aids. — As an expectorant, ipecacuanha, squill, and senega. 

Physiological Effects. — The physiological effects of the am- 
monium salts have been considered under the head of Ammonia 
Preparatio?ts {vide p. 220). The local action of ammonium chloride 
is that of an irritant. In large doses it purges. In small doses, 
after absorption, it proves a powerful resolvent-alterative, diminish- 
ing the solid constituents of the blood, with an increased flow of 
the secretions generally ; it has an especial action upon the mucous 
membranes, promoting nutritive changes and epithelial exfoliation. 
Under its use the solids of the urine are increased, except uric acid, 
which is slightly diminished. Even in very large amounts it is not 
considered poisonous. 

Medicinal Uses. — It is not much employed either in Great 
Britain or the United States, but is extensively used in Germany 
as a refrigerant in mild fevers attended with stoppage of the 
secretions ; as a resolvent in organic enlargements ; and in 
amenorrhoea. It is used in acute bronchitis and pneumonia as 
an expectorant, combined with fluid extract of glycyrrhiza (which 
somewhat disguises its unpleasant taste) and with other expector- 



468 MATERIA MEDIC A AND THERAPEUTICS. 

ants: ty, Ammonii chloridi, 3ij; extracti glycyrrhizae fluidt, f3j; 
syrupus ipecacuanhas, f§iv; syrupus pruni virginianae, foiij; sy- 
rupus tolutani, q. s. foyj. M. et Sig. — A dessertspoonful every 
three or four hours in acute bronchitis when expectoration is begin- 
ning to be established. Of late this salt has been used with ad- 
vantage in muscular rheumatism and in neuralgia; and its resolvent 
powers are highly spoken of in uterine fibroids. Dr. Peters* ad- 
vocates its use in large doses combined with Huxham's tincture 
in rheumatic affections of the joints. In albuminoid or waxy infil- 
tration of the liver it is of undoubted avail in doses of gr. x-xxt. d. 

In the early stages of cirrhosis of the liver it is of value, and it 
has been highly recommended in torpidity of the liver, chronic 
hepatitis, etc., but according to the experiments of Rutherford and 
Vignal, it does not increase the secretion of bile, although they 
found it stimulated the intestinal glands. 

Administration. — Dose, gr. v-xxx every two or three hours, 
in aqueous solution disguised with simple elixir, or syrup of 
orange. Externally it is used in solution (immediately upon being 
dissolved) as a refrigerant lotion (§j to water Oss), in cutaneous 
afffections and indolent ulcers (5j to water Oss). Troches of 
ammonium chloride each contain ammonium chloride gr. ij with 
sugar, tragacanth, and syrup of tolu. 

AMMONII PHOSPHAS— AMMONIUM PHOSPHATE. 

Preparation and Description. — It is made by adding stronger 
water of ammonia to diluted phosphoric acid, evaporating and 
crystallizing ([NH 4 ] 2 HPOJ. It occurs in transparent, colorless 
crystals, having the form of six-sided tables, of an alkaline, some- 
what saline taste, soluble in water, and insoluble in alcohol. As 
usually found in the shops, it is a mixture of the neutral and of the 
acid ammonium phosphate. 

Incompatibles. — Same as for ammonium chloride. 

Effects and Uses. — This salt enjoys considerable reputation 
as an alterative. It has been used in this country as a remedy in 
gout and chronic rheumatism. In combination with ammonium 
carbonate and aromatic spirit of ammonia, it has also been given 
with advantage in diabetes mellitus. 

Administration. — Dose, gr. x-xl three or four times a day, 
dissolved in an aromatic water. 

• N. Y. Med. Rec, Jan. 23d, 1886. 



ALTERATIVES— POTASSIUM CHLORATE. 469 



POTASSII CHLORAS— POTASSIUM CHLORATE. 

Preparation, Description and Tests. — This salt is prepared 
by various processes: a good one is by reaction upon solution of 
caustic potassa, mixed with lime, with a stream of chlorine ; the 
chlorine is converted into chloric acid by oxygen from the lime, and 
the acid combines with the potassium to form potassium chlorate 
(KCIO3). It is a white, anhydrous salt, crystallizing in rhomboidal 
plates of a pearly lustre, and is inodorous, and of a cool, saline 
taste. It is but little changed by exposure to the air; it is soluble in 
16 parts of coid water or 2 parts of boiling water. It is said to be 
soluble in all the animal fluids without decomposing them or under- 
going change itself. Tests — When a few drops of H 2 S0 4 are 
added to KC10 3 an explosive gas resembling chlorine is evolved. 
Potassium chlorate heated in a test tube yields oxygen. 

Incompatibles. — It should not be prescribed in powder with the 
metallic sulphides, sulphur, glycerin, the vegetable powders, as tan- 
nin and catechu, as when triturated with these substances it parts 
with some of its oxygen to form explosive compounds. 

Physiological Effects. — In its effects potassium chlorate 
resembles the other potassium salts (see p. 253), especially the 
nitrate. Introduced by the stomach, it is rapidly absorbed un- 
altered (Isambert*). When taken internally for some time, it gives 
a bright, arterial tinge to the venous blopd, and reduces the volume 
and frequency of the pulse. It does not diminish the excretion of 
the urea, but largely increases the secretion of urine, by which it 
rapidly passes out of the system unchanged, as well as by the saliva 
(Rabuteauf). It has been pointed out by Dr. Jacobi that when 
given for some time this salt produces irritation of the kidneys and 
finally chronic tubal nephritis. The appetite is improved under its 
use, and salivation is an occasional result. 

Toxicology and Antidotes. — Large doses may be taken with 
impunity, but excessive quantities have produced fatal gastro-enteric 
inflammation. In the case of Dr. Fountain.^ who died from swal- 
lowing oj, taken to prove its inertness, violent gastro-enteritis set 
in, and at the end suppression of urine, with death in seven days. 



* " Etudes din., physiol., et chim. sur Temp, therap. du chlorate de potassa.' ' 1856, 
Paris. 

f Gaz.Hebdom., V, 1868, p. 705. \ Am. Med. Times, 1861, p. 245. 



470 MATERIA MEDICA AND THERAPEUTICS. 

Fatal cases of poisoning from this salt have been reported, appar- 
ently from blood-poisoning, the heart and large vessels having been 
found filled with coagula. In cases of poisoning the stomach 
should be emptied and then demulcents as starch-water or arrow- 
root administered. 

Medicinal Uses. — As it contains a large amount of oxygen, it 
was at first employed with a view to its oxidizing influence in con- 
taminated conditions of the blood, as in malignant fevers, etc., but 
as it ordinarily does not part with oxygen except when exposed to 
a very high temperature, (67 1° F.), this view of its action is now 
obsolete. It is still considered a valuable alterative in typhus, 
scarlatina, etc., by many practitioners. Probably its most positive 
remedial effects are seen in various forms of stomatitis, follicular, 
mercurial, and gangrenous. It is used also in diphtheria, croup, and 
even neuralgia. Externally, in solution, it is an admirable wash or 
gargle in stomatitis, tonsillitis, hoarseness, ozcena, the sore throat of 
scarlatina, acute and chronic pharyngitis y diphtheria, and fetid, ulcer- 
ated surfaces generally ; mixed with sugar, the powder is an excel- 
lent application in the aphthous sore mouth of children. 

Administration. — Dose, internally, gr. v-xxx three or four 
times a day in water with some pleasant vehicle, as syrup of orange. 
Troches of potassium chlorate (trochisci potassii chloratis) are made 
by rubbing together potassium chlorate, sugar, tragacanth, spirit of 
lemon, and with water forming a mass; each troche contains 5 
grains of potassium chlorate — serviceable in pharyngeal cough and 
hoarseness. For external use, 5ij-iv may be dissolved in water, Oss. 

Sodii Chloras {Sodium Chlorate) (NaC10 3 ). This salt may be 
made in the same way as potassium chlorate, substituting a solution 
of soda for that of potassa. It occurs as colorless, transparent 
tetrahedrons, permanent in dry air, odorless, with a cooling, saline 
taste, readily soluble in water, soluble also in alcohol. 

Incompatibles. — Same as for potassium chlorate. 

Medicinal Uses. — In effects and uses it is similar to potas- 
sium chlorate, but milder in its action. It is not much used inter- 
nally. Dose, gr. v-xx. 

POTASSII BICHROMAS— POTASSIUM BICHROMATE. 

The chief ore from which salts containing chronium are 
obtained is chrome ironstone, found in Sweden and south-eastern 
Pennsvlvania. 



ANTACIDS. 471 

Preparation and Description. — By roasting the powdered 
ore with potassium carbonate and nitre, the (yellow) potassium 
chromate is obtained, and by acidulating a solution of this with 
sulphuric acid, the (red) bichromate is formed (K 2 Cr 2 7 ); it separates 
in orange-red, anhydrous, tabular crystals, soluble in water, in- 
soluble in alcohol, and of a cooling, bitter taste. 

Incompatibles. — Soluble salts of mercury, silver, lead, liquor 
potassae, sodae and ammonia water, form new compounds with this 
agent and may be used as tests. 

Toxicology. — Two drachms have caused death,* while a 
youth f recovered after taking oij, though it produced severe 
gastro-enteric inflammation. 

Lafleur and RuttanJ report the death of an adult male after 
the ingestion of §ij. There was intense cyanosis of the surface, 
the liver and kidneys being purple, the oesophagus stained yellow, 
and the blood of a brown color. The interesting discovery was 
made that the hemoglobin was found changed to methemoglobin, 
which may account for the quickly fatal results of this drug. 

Effects and Uses. — It is an irritant caustic, acting in over- 
doses as a corrosive poison for which the proper antidotes are 
magnesia, soap and the alkaline carbonates. In small doses it is 
alterative. In large amounts it is emetic. 

Administration.— Externally it is a good application, in pow- 
der or in saturated solution, to warts, chancroids, etc. Dose, as an 
alterative, gr. \ daily, in pill with some bitter extract; as an emetic, 
gr. y^. It is almost never given internally. 

ORDER III.— ANTACIDS. 

Antacids are medicinal agents employed to neutralize acids 
in the blood, primae viae and secretions. The alkalies and alkaline 
earths and their carbonates are the substances included in this 
division. The alkalies, in the concentrated state, destroy organiza- 
tion and act as corrosive poisons; they are administered internally 
only in a state of extreme dilution. The alkaline carbonates pro- 
duce a less intense chemical action on the tissues than the alkalies; 
and the bicarbonates are less active than the mono-carbonates. 



Woodman and Tidy, 1882, p. 169. f Guy's Hosp. Reports, 1851, p. 214. 

% Montreal Med. Journ., Aug., 1888. 



472 MATERIA MEDICA AND THERAPEUTICS. 

The alkaline earths, particularly magnesia/ are less energetic in 
their local action than the alkalies proper; and their carbonates 
manifest little or no chemical influence upon the tissues. 

When swallowed in a state of dilution, the alkaline preparations 
combine with the free acids which they encounter in the stomach. 
The salts which are thus formed, unless carried off by the bowels, 
are absorbed into the blood, and are thrown out by the secretions, 
especially by the kidneys. It must be remembered that, as already 
stated (see p. 254), alkalies increase acid and diminish alkaline 
secretions, when in contact with the orifices of the glands which 
secrete them. In like manner, acids increase alkaline and diminish 
acid secretions (Ringer) (see pp. 177, 258). While in the intestines, 
besides neutralizing acids, the alkalies also promote the digestion 
and absorption of fatty substances, by forming with them an emul- 
sion. After absorption they exert a liquefacient action on the 
blood, and render the urine alkaline. Their long-continued use dis- 
orders the functions of digestion and nutrition, produces a chronic 
deterioration of the blood, and sets up a cachectic condition some- 
what analogous to scurvy. 

In the concentrated form the alkalies are employed as escharotics. 
The various alkaline preparations are administered internally, in the 
diluted form — 1. As antacids , in dyspepsia accompanied with ex- 
cess of acid in the primae vise, and they are probably also of advan- 
tage in dyspeptic cases, by promoting the digestion of fatty matters. 
As dyspepsia with acidity probably depends frequently on fermenta- 
tion of the ingesta, due to deficient secretion of acid gastric juice, 
the administration of the alkalies would prove of advantage, not by 
neutralizing the acid in the stomach, but by correcting the deficiency 
of the secretion on which the dyspepsia depends. If the condition, 
on the other hand, depend on a profuse secretion of acid, then the 
administration of the alkalies can do nothing more than palliate, by 
neutralizing, the excessive acidity. When the alkalies are exhibited 
before meals, they increase the acid secretion of the gastric mucous 
membrane ; given after meals they neutralize the excess of acid. 
Acids taken before meals decrease the amount of acid secreted by 
the stomach ; while, if given after meals, they will supply the place 
of the acid of the gastric juice, should there be a deficiency in that 
secretion. The vegetable tonics and aromatics are frequently com- 
bined with antacids advantageously, in the treatment of dyspepsia. 
2. To relieve irritability of the stomach and check vomiting 3. As 



ANTA CIDS—PO TASSIUM PREPARA TIONS. 473. 

antidotes in cases of poisoning from acids. 4. As antilithics, to 
neutralize uric acid when it is separated in undue quantity by 
the urine ; and also as lithoutriptics, or solvents of calculi, espe- 
cially urates. They are improper when there is a tendency to the 
deposition of phosphates ; and in treating cases of uric acid deposit 
it is unnecessary to render the urine more than neutral, as, if it be 
made alkaline, the phosphates formed may be deposited round the 
uric acid calculi. 5. In the treatment of acute rheumatism and 
gout, where they act by neutralizing the excess of acid with which 
the blood is charged in these diseases. 6. To relieve irritability of 
the urinary organs — ardor urinae in gonorrhoea — cutaneous irrita- 
tion — uterine irritation — pruritus ani, etc. — especially when these 
conditions of irritability are dependent, as is often the case, on excess 
of acid in the system. 7. As diuretics. 8. As antiplastics and 
resolvents, in inflammation. And, 9. By many therapeutists, in 
diabetes mellitus. 

The antacid preparations should be administered in a state of 
large dilution, with a view to facilitate their absorption, and to pre- 
vent an irritant and purgative action on the bowels. 

POTASSII PR^E PAR AT A— POTASSIUM PREPARATIONS. 

The preparations of potassium employed as antacids are the 
Solution of Potass a, Potassium Carbonate and Potassium Bicarbo?iate. 

The general effects of the potassium preparations are those pre- 
viously described (see p. 253). They increase both the solid and 
watery portions of the urine, and in large doses render it alkaline. 
Under their use, however, the uric acid, either free or combined, is 
greatly diminished, and, it is asserted, is converted into oxaluric 
acid, which is metamorphosed into oxalic acid and urea. 

Liquor Fotassae {Solution of Potassa) is prepared by the action 
of lime on a solution of potassium bicarbonate ; the lime abstracts 
carbonic acid from the bicarbonate, and precipitates as calcium car- 
bonate, leaving the potassium hydrate in solution ; or it may be 
made, more directly, by dissolving potassa, 56 parts, in distilled 
water, 944 parts. Solution of potassa is a limpid, colorless liquid, 
without smell, of a very acrid, caustic taste, an alkaline reaction, and 
imparts a soapy feeling to the fingers when rubbed with it ; sp. gr. 
1.036; it contains 5 per cent, of potassium hydrate (KHO). 

Incompatibles. — With acids, acid salts, and all substances held 



,474 MATERIA MEDICA AND THERAPEUTICS. 

in solution by the same agency ; also with the ammoniacal salts, 
calomel and corrosive sublimate. 

Aids. — Liquor sodae. 

Contraindications. — Phosphatic calculi, or the phosphatic 
diathesis. 

Toxicology and Antidotes. — In excessive quantity it acts as 
an irritant and corrosive poison ; vegetable acids should be admin- 
istered as a chemical antidote, and oils as a protective. 

Effects and Uses. — The antacid, diuretic, antilithic and resolve?tt 
properties and indications of this preparation have been described 
above. It is more irritant to the stomach than the potassium car- 
bonates, and is therefore less eligible for protracted use. To render 
the urine alkaline in acute cystitis, Sir H. Thompson prefers it to 
the carbonates and citrates, as it is less diuretic. For the same 
reason it is useful in gonorrhoea and strangury. It may be admin- 
istered to neutralize gastric acidity in heartburn and eructations, pos- 
sessing the advantage over the carbonates of not giving off carbonic 
acid gas. 

Administration. — Dose, gtt. x-xx, largely diluted with sweet- 
ened water or mucilage. Externally it is used in a diluted state as 
a stimulant lotion in prickly heat and freckles, and to acne when the 
skin is greasy. 

Potassii Carbonas {Potassium Carbonate, commonly called Salt 
of Tartar). This salt is prepared by calcining potassium bicarbonate, 
which is thus deprived of a molecule of carbonic acid and reduced 
to the state of carbonate (2KHC03=H 2 C0 3 +K 2 C0 3 ). Potassium 
carbonate occurs in the form of a white, coarse, granular powder, 
of a nauseous, alkaline taste and an alkaline reaction, very soluble 
in water, but insoluble in alcohol. It is very deliquescent, forming, 
if long exposed to the air, an oily liquid with the water, which it 
attracts. 

Incompatibles. — Acids, acidulous salts, calcic hydrate and 
chloride, magnesium sulphate, ammonium chloride and acetate, 
alum, tartar emetic, iron sulphate and tincture of ferric chloride. 

Contraindications. — Same as for liquor potassae. 

Toxicology and Antidotes. — In large quantities it acts as a 
corrosive . poison, for which vegetable acids are the chemical anti- 
dotes. Fixed oils should be given to protect the stomach. So 
much as fSiij of a concentrated solution has been swallowed without 
fatal results. 



ANTA CIDS— SODIUM PREPARA TIOXS. 475 

Effects and Uses. — It is employed as an antacid, anaplastic, 
diuretic, autilithic, etc., in the dose of gr. x-xx, in some sweetened 
aromatic water. It has been found specially useful in torpor of the 
liver, in dyspepsia as an antacid, and as an antilithic in the uric acid 
diathesis. 

Potassii Bicarbonas {Potassium Bicarbonate) is made by passing 
carbonic acid through an aqueous solution of purified pearl-ash (a 
more or less impure potassium carbonate), obtained from wood-ashes 
by lixiviation, and somewhat purified by solution in water, filtration 
and evaporation, till it is fully saturated. It occurs in transparent, 
colorless crystals, having the shape of irregular eight-sided prisms 
with two-sided summits (KHC0 3 ). They are inodorous, of a slightly 
alkaline taste, permanent in the air, soluble in water, and insoluble 
in alcohol. 

Incompatibles. — Same as for the carbonate, except no precipi- 
tate is formed with calomel or Epsom salt. 

Effects and Uses. — These are similar to those of the car- 
bonate, but it is pleasanter in taste and less irritant to the stomach. 
It is much used in gout and the uric acid diathesis. It is a good 
remedy in acute rheumatism, in which as much as Sjss may be given 
during the day, with opium to relieve pain. Dose, gr. xx-5j. 

Fuller's alkaline* treatment of acute rheumatism consists in 
giving large doses so as to thoroughly alkalmize the system, together 
with the strictest attention to the diet and the administration of 
tonics, as quinine, as soon as the system will tolerate them. He 
gives of potassium bicarbonate not less than Sjss in the first twenty- 
four hours, either alone or in combination with a vegetable acid 
largely diluted with water. When the urine becomes neutral the 
bicarbonate is reduced to a quantity just sufficient to keep it so (from 
5/^-J^ thrice daily). Of 439 cases treated by this plan, in only 2 
per cent, were cardiac complications discovered. Fuller's treatment 
is best adapted to the obese and plethoric. 

sodii prjeparata-sodium preparations. 

The sodium preparations are analogous in effects to those of 
potassium. Ringer and Sainsburyf have shown that they stop the 
extirpated frog's heart in diastole. SchoenleinJ, too, found that 



* The Practitioner, Vol. II, p. 129. f Lancet, 1882, p. 736. 

%Arch.f. d. Ges, Physiol., XVIII, p. 26. 



476 MATERIA MEDIC A AND THERAPEUTICS. 

sodium carbonate acted directly on the heart and not through the 
nerves. In regard to their relative poisonous activity, the former 
ascertained that potassium stands first, then ammonium, while sodium 
possesses only slight toxic power. Being less irritant and less de- 
pressing, they are better as antidyspeptics, and for the relief of 
acidity of the primae viae. They are inferior in gout and the uric 
acid diathesis, as they are less powerful solvents of the acid. Their 
eliminative action as diuretics is also more feeble. 

Liquor Sodas (Solution of Soda) is prepared by the action of 
lime on a solution of sodium carbonate, or by dissolving soda 56 
parts in distilled water 944 parts. It is a colorless liquid, having 
an extremely acrid taste and a strong alkaline reaction. It has sp. 
gr. 1.059, an d contains 5 per cent, of sodium hydrate (NaHO). 
The dose, administration and incompatibles are the same as those 
of liquor potassse. 

The preparations of sodium generally employed as antacids 
are the carbonates. There are several sources of carbonated 
sodium. The native carbonate (called natro?t) is found in Egypt, 
Hungary and other countries. Impure soda, obtained from the 
ashes of marine plants, is termed barilla or kelp — barilla when it is 
derived from phenogamous plants growing near the sea, and kelp 
when procured from cryptogamic plants growing in the sea. So- 
dium carbonate is now, however, chiefly made by artificial means 
from sodium sulphate, which is obtained in part from the manufac- 
turers of chlorinated lime, but principally by the action' of sulphuric 
acid on sodium chloride. The sodium sulphate is fused with ground 
limestone and coal, and forms a black mass called British barilla, 
which contains a mixture of sodium carbonate and calcium sul- 
phide— Na 2 S0 4 + Q + CaCO s = CaS + Na 2 C0 3 + 4CO. It is 
afterward purified by lixiviation, calcination and other processes. 
Within a few years past, caustic soda and the carbonates and other 
sodium salts have been manufactured near Pittsburgh, in Pennsyl- 
vania, from cryolite (a sodium and aluminium fluoride) (3NaF,AlF 3 ), 
which is found in an immense deposit in Greenland, and largely 
imported into Philadelphia. Sodium carbonate, too, has been 
found in large amount in a lake in Nevada. 

Sodii Carbonas (Sodium Carbonate) (Na 2 C0 3 .ioH 2 0) crystallizes 
in large, oblique, rhombic prisms, which are transparent, very efflor- 
escent, of an alkaline, disagreeable taste, soluble in water, but in- 
soluble in alcohol. When heated they undergo the watery fusion 



A NTA C1DS— SODIUM PREPARA TIONS. 477 

and part with their water of crystallization, which is entirely ex- 
pelled at a red heat. It is apt to contain sodium sulphate and 
chlorides as impurities. 

Incompatibles. — Acids, acidulous salts, lime-solution, earthy 
and metallic salts, etc., are incompatible with sodium carbonate. 

Aids. — Liquor potassae. 

Contraindications. — Phosphatic calculi, and the phosphatic 
diathesis. 

Toxicology and Antidotes. — In overdoses it is a corrosive 
poison, for which acids and oils are the antidotes. 

Effects and Uses. — Sodium carbonate is less irritant and has 
a milder and more agreeable taste than potassium carbonate. Its 
effects are otherwise similar, and it is administered in the same cases. 

Administration. — Dose, gr. x-xxx in powder, or dissolved in 
some bitter infusion. Owing to the variable quantity of water of 
crystallization which it contains, as kept in the shops, it is best 
given in the dried state. 

Sodii Carbonas Exsiccatus -{Dried Sodium Carbonate). — This 
salt is deprived of its water of crystallization by heat, and occurs 
in the form of a white powder. Dose, gr. v-xv in pill, made with 
soap and aromatics. 

Sodii Bicarbonas (Sodium Bicarbonate) (NaHC0 3 ) is prepared 
by saturating the carbonate with carbonic acid. The half-dried 
carbonate is made to absorb carbonic acid, the water liberated 
during its solution being sufficient to dampen it. Thus ob- 
tained, the crystals have the form of the carbonate, retain- 
ing only one equivalent of water, but are opaque and porous. 
They occur usually in granular masses, or in the form of a white, 
opaque powder, which contains variable amounts of soda not fully 
saturated with carbonic acid, and is known as sodii bicarbonas 
venalis {commercial sodium bicarbonate). This is purified for 
medicinal use by percolation with distilled water, and the purified 
salt occurs as a snow-white powder, soluble in 13 parts of water, 
of a mild, slightly alkaline taste. It is a permanent salt. By ex- 
posure to heat it gradually parts with its carbonic acid, and at a red 
heat is converted into the anhydrous carbonate. 

Incompatibles. — With acids, acidulous salts, lime-water, am- 
monium chloride, the earthy and metallic salts. 

Contraindications. — Phosphatic calculi, and the phosphatic 
diathesis. 



478 MATERIA MEDICA AND THERAPEUTICS. 

Effects and Uses. — These are the same as those of the 
carbonate, but it is less irritant and of more agreeable taste. It 
is often combined with aromatics in acid dyspepsia or flatulence, 
and in headache due to these causes : ^ Sodii bicarbonatis, 
5ij ; tincturae nucis vomicae, f 5ij ; tincturae zingiberis, f5iv; 
tincturae capsici, f 5j ; sacchari albi, Sss; aquae menthae piperitae, 
q. s. f Syj. M. S. Of this, a dessertspoonful may be taken three 
or four times a day. Sodium bicarbonate is an ingredient of Seid- 
litz powders (q. v.). A most serviceable alkaline-cleansing wash 
for chronic nasal catarrh, highly recommended by Morell Mackenzie, 
is composed of sodii carbonatis, sodii boratis, sodii chloridi, aa gr. 
vij, sacchari albi gr. xv, M. S.; dissolve in half a- tumblerful of tepid 
water; to be used as a nasal douche. Troches of sodium bicarbonate 
contain sodium bicarbonate, sugar, nutmeg, and mucilage of traga- 
canth, each troche containing gr. iij of the bicarbonate. Externally, 
sodium bicarbonate may be sprinkled with advantage over burns 
and scalds ; or a solution of S^ to water Oij may be applied to 
the parts, on lint, to alleviate the pain (McClellan* and Springf). 
Equal parts of it and common salt make a good application to the 
bites of bees, hornets, and spiders. 

Administration. — Dose, for an adult, gr. x-xxx, which may 
be pleasantly taken in carbonic acid water. 

Sternberg' s \ alkaline treatment of yellow fever, for which ex- 
cellent results are claimed, consists in administering a certain 
amount of sodium carbonate with a minute portion of corrosive sub- 
limate as follows : Tfy Sodii bicarbonates §iv, hydrargyri corrosivi 
sublimati gr. y 2 , aquae Oij. M. S. Take i^ ounces every hour. 

ALKALINE MINERAL WATERS— NORTH AMERICAN. 

St. Louis Spring {Gratiot County, Michigan). Analyst S. P* 
Duffield, M. D. Temperature 50 Fahr. One pint contains chiefly 
sodium carbonate, gr. 7.684; magnesium carbonate, 1.080; iron car- 
bonate, 0.091 ; calcium carbonate, 5.019; calcium sulphate, 6.925 ; 
carbonic acid gas, 136 cubic inches; hydrogen sulphate, trace. 
A strongly alkaline water containing a little iron; particularly bene- 
ficial in dyspepsia with acidity ; neuralgia and chronic rheumatism. 

Capon Springs {Hampshire County, West Virginia, elevation 



* Louisville Med. News, 1878, p. 108, f Phila. Med. Times, March, 1878, p. 273. 
% Therap. Gaz., May 15th, 1889. 



ANTACIDS— ALKALINE MINERAL WATERS. 479 

1S00 feet above the sea). Contains sodium and magnesium carbon- 
ates, also iodine and bromine, and is highly charged with carbonic 
acid gas. Temp. 66° Fahr., has but litle odor. Employed in acid 
dyspepsia, the uric acid diathesis and chronic cystitis. 

Poland Spring (South Pola?id, Maine). Analyst, Prof. C. F. 
Chandler. One U.S. gallon contains potassium sulphate, gr. 0.1562; 
sodium chloride, 0.2636; sodium carbonate, 0.1333 ; calcium car- 
bonate, 1.2287 ; magnesium carbonate, 0.5412 ; silica, 1.1197; or- 
ganic and volatile matter, 0.2332. Total solids, 3.6759. 

Bedford Chalybeate Spring {Bedford County, Pennsylvania). 
One U. S. gallon contains, calcium sulphate, gr. 2.741 ; calcium 
carbonate, 8.885 \ magnesium carbonate, 1.201 ; iron carbonate, 
.442; sodium carbonate, .395 ; potassium carbonate, .132 ; sodium 
chloride, .120 ; silicic acid, .793 ; calcium phosphate, .033. Total 
solids, 14.942. Carbonic acid gas, 12 cubic in. The conditions in 
which these waters prove of service are the uric acid diathesis, 
clironic rheumatism, gout, diabetes mellitus, acute and chronic Brighfs 
disease, renal calcidi, jaundice, gall-stones, and acute and chronic 
hepatitis. 

ALKALINE MINERAL WATERS— EUROPEAN. 

Apollinaris (Valley of the Ahr, Rhenish Prussia). One pint 
contains sodium carbonate, gr. 6.964; magnesium carbonate, 
2.751; calcium carbonate, 1.900; sodium chloride, 2.743 ; sodium 
sulphate, 1.548; oxide of iron with alumina, 0.049; silicic acid, 
0.099 ; total solids, 16.054. Gases: carbonic acid, free and semi- 
combined, cub. in. 42.81; carbonic acid combined, 12.44. An 
agreeable and palatable alkaline mineral water, extensively taken 
as a table-water. 

Vichy (France); Ems (Germany) ; Fachingen (Germany). The 
Vichy waters do not act on all alike. To some they prove 
purgative, to others diuretic ; but they invariably render the urine 
alkaline. There are nine springs in all the temperature of which 
ranges from 53 to 110 Fahr., and they are employed as baths as 
well as internally. Taken during or after digestion 'they check 
acidity ; administered before they augment the acid gastric secre- 
tion. The Ems waters increase the urinary secretion and perspira- 
tion, render the urine alkaline, and tend to produce constipation. 
The Vichy waters are prescribed in dyspepsia with acidity and con- 
stipation ; in biliary calculi, gall-stones, renal calcidi, gout, diabetes 
mellitus, malarial cachexia, and to neutralize the urine in strangury. 



480 



MATERIA MEDICA AND THERAPEUTICS. 



The Ems waters, which are limpid and soft to the touch, are pre- 
scribed with benefit in chronic bronchitis, pharyngitis, chronic cystitis, 
and endometritis. The Fachingen waters are used in the same way 
as the Vichy. There is no resort at the latter spring. 



ONE PINT CONTAINS 


VICHY. GRANDE 
GRILLE. 

IO5. 8° FAHR. 

BOUQUET. 


FACHINGEN. 
50° FAHR. 

FRESENIUS. 


EMS, KESSELBRUN- 

NEN. 

1 15° FAHR. 

FRESENIUS. 


Potassium carbonat 
Sodium carbonate 
Magnesium carbon 
Iron carbonate .' 
Magnesium carbons 
Calcium carbonate 
Lithium carbonate 
Strontium carbonate 
Barium carbonate 
Sodium chloride 
Calcium chloride 
Potassium sulphate 
Sodium sulphate 
Sodium phosphate 
Aluminum phospha 
Calcium phosphate 
Lithium phosphate 
Silicon phosphate 
Calcium fluoride 
Sodium biborate 
Sodium arseniate 
Silica 


e 

ite 

life 

te 








grair 

2< 

( 

ti 

c 

I 
( 

tl 
c 
c 


is. 

2.04 

3.00 

1.38 

D.02 

•ace 
2.31 

).oi 
HO 

2.29 
>.78 

•ace 

).OI 

X05 


grains. 

19.4763 

1.3580 
0.0801 

2.IOIO 

0.0004 
0.0007 

4.5574 
0.0034 

0.1372 
0.0506 
0.0003 
0.0004 
0.0002 
0.2610 
0.0027 


K 

< 
c 
c 

] 

< 
( 

c 
c 

c 
c 


air 

>.5 

xS 
).o 
).o 

.2 

xo 
).o 

'■7 

>-3 

).o 

).o 
>-3 


is. 

37 
5i 
20 

03 
59 

03 
03 
70 

93 
06 

09 
64 


9 


2 

5 

1 




5 

7 

1 

6 
8 


Total . 










3* 


5.99 


27,9397 


2 


.2 


19 


4 



GASES. 


cub. in. 


cub. in. 


cub. in. 


Carbonic acid 


14.74 


32.975 


67.88 



LITHII PR^EPARATA— LITHIUM PREPARATIONS. 

Lithium is found in several minerals, as lepidolite, etc., but in 
minute amount. It is extracted chiefly by the agency of sulphuric 
acid ; the sulphate is converted into a chloride by a solution of bar- 
ium chloride, and from the chloride, the carbonate (Lithii Carbonas) 
(Li 2 C0 3 ) is prepared by the addition of ammonium carbonate. It is 



ANTACIDS— LITHIAN MINERAL WATERS. 481 

a white powder of a mildly alkaline taste, soluble in 130 parts of 
water, more soluble in carbonic acid water, and insoluble in alcohol. 

Incompatibles. — With acids, acidulous salts and the agents 
that decompose the alkalies. 

Effects and Uses. — The lithium salts act on the system in a 
similar manner to the other alkalies. They are said to render the 
urine more alkaline than do the other members of this group. 
Lithium carbonate is a very valuable antacid in gout and rheuma- 
tism, from the fact of its low combining number and the great 
solubility of the lithium urate, thus enabling the carbonate to act 
powerfully in eliminating uric acid from the system. Garrod * 
who first called attention to lithium in the treatment of gout, ex- 
perimentally proved its efficiency as a solvent of uric acid deposits 
by placing a metacarpal bone and bit of cartilage, both of which 
were infiltrated with gouty nodules, in a solution of lithium carbon- 
ate, which in a few days dissolved away the deposit. It probably 
also diminishes the formation of uric acid, and the author has found 
it highly efficacious in the cure of gout. It is, too, a good diuretic. 

Administration. — Dose, gr. v-x two or three times daily, 
largely diluted and best given in carbonic acid water. 

Lithii Citras (Lithium Citrate) (Li 3 C 6 H 5 7 ), a deliquescent white 
powder, soluble in 2.5 parts of water, is made by adding a solution 
of citric acid to the lithium carbonate. It is converted into a car- 
bonate in the system, and is, therefore, possessed of the same prop- 
erties, but is more refrigerant. Strong solutions of the lithium salts 
have been found useful externally in removing gouty enlargements. 

Lithii Benzoas (Lithium Benzoate) (LiC 7 H 5 2 ) is prepared by 
the gradual addition of benzoic acid to a heated watery solution of 
the carbonate, and evaporating. It may be obtained in the form of 
glistening pearly scales, of a soapy feel and a cool, sweetish taste, 
soluble in three and a half parts of water at 6o°. The ready solu- 
bility of this salt and its freedom from deliquescence, and the benzoic 
acid which it contains in combination, give it especial value in the 
treatment of the various forms of disease dependent upon uric acid 
deposits. Dose, gr. iij-v repeated. 

lithian mineral waters. 
Ballston Spa (Saratoga County, New York). Analysis of 
the Ballston Lithium well by Prof. C. F. Chandler ; temperature 5 2° 

* "Gout and Rheumatic Gout,'' 1859, p. 435. 

3 1 



482 MATERIA MEDICA AND THERAPEUTICS. 

Fahr. In addition to lithium carbonate of which there is gr. ^ to 
the pint, this water contains a large quantity of sodium chloride, 
calcium and magnesium carbonates. 

Saratoga Springs (New York, Pavilion Spring). This yields 
in addition to the carbonates and sodium chloride about gr. ^ of 
lithium carbonate to the pint. 

These waters are useful in gout, chronic rheumatism, and the 
uric acid and gouty diatheses. 

AMM0N1I PR^PARATA-AMMONIUM PREPARATIONS. 

The preparations of ammonia (previously noted under the head 
of Stimulants, p. 220) are administered as antacids, in cases in which 
a stimulant action is not objectionable. Spiritus ammonia aromati- 
cus (aromatic spirit of ammonia) is the preparation usually employed, 
and is an excellent antacid carminative in heartburn attended with 
flatulence *' nausea with syncope, etc. Dose, gtt. xxx~f5j. 

MAGNESII PR^EPARATA— MAGNESIUM PREPARATIONS. 

Magnesia (q. v.) and its Carbonate (q. v.) are employed as 
antacids in dyspepsia, sick headache, gravel, etc., particularly where 
a laxative effect is also desirable. Dose, gr. x-xxx. Troches of 
magnesia are made by mixing magnesia, nutmeg, sugar, and form- 
ing with mucilage of tragacanth a mass, each troche containing gr. 
iij of magnesia. 

CALCII PR^EPARATA-CALCIUM PREPARATIONS. 

The preparations of calcium employed as antacids, are Lime- 
solution, Precipitated Calcium and Prepared Chalk. They are very 
useful in cases of acidity or irritability of the stomach, but their 
action on the bowels is the reverse of that of magnesia, and hence 
they can hardly be administered where there is a tendency to con- 
stipation. They are also much employed in diarrhoea. 

Liquor Calcis (Lime -Solution, Lime-water) is a saturated solu- 
tion of lime in distilled water. It is a colorless, inodorous liquid, 
of a disagreeable alkaline taste, containing about 0.15 per cent, of 
calcium hydrate (Ca2HO). By exposure to the air it gradually 
absorbs carbonic acid, with the formation of insoluble calcium car- 
bonate. It should, therefore, be kept in full, well-stoppered bot- 
tles, or they should contain some undissolved lime. 

Incompatibles. — With sulphuric acid, ammonium phosphate, 



ANTACIDS— CALCIUM PREPARATIONS. 483 

sodium carbonate, potassium carbonate, magnesium sulphate, am- 
monium chloride, alum ; the lime carbonate with acids and acidu- 
lous salts. 

Contraindications. — Oxaluria. 

Effects and Uses. — Lime-water combines antacid and as- 
tringent properties, and is applicable to all the cases in which 
antacids are proper, where an astringent effect on the bowels is not 
objectionable. It is an excellent remedy in gastric irritability, at- 
tended with nausea and vomiting, and may be given mixed with 
an equal part of milk, which disguises its unpleasant taste. A diet 
of milk and lime-solution is very useful in dyspepsia, accompanied 
with vomiting of food. Lime-water is employed also in acute 
diarrhoea after the inflammation has been subdued; in diabetes mel~ 
litus, and in pyrosis. Externally it is used as a lotion in tinea 
capitis, prurigo, scabies ; as a mouth wash in fetor of the breath, 
sordes and mercurialismus ; as an application to fotd ulcers t and as 
an injection in leucorrhcea and gleet. Atomized inhalations of lime 
solution have been found useful in diphtheria and membranous 
croup. 

Administration. — Dose, internally, foss-iij-iv several times a 
day; for children, f3j. Linimentum calcis [lime-linime7tt) (equal 
parts of lime-solution with cotton-seed oil, sometimes called carron 
oil) is an invaluable liniment in Hums and scalds, and in small-pox. 

Syrupus Calcis [Syrup of Lime) contains 5 per cent, of lime 
and 30 per cent, of sugar. It has been used as an astringent in 
diarrhoeas, and as an antidote to poisoning by carbolic acid. It is 
much stronger than lime-water, Tfl.xx of the syrup being equal to 
foj of the latter. Dose, f5ss-ij, well diluted. 

Calcii Carbonas Praecipitatus [Precipitated Calcium Carbonate) 
(CaC0 3 ) is made by mixing boiling solutions of calcium chloride 
and sodium carbonate. It is a fine white powder, insoluble in 
water, and free from grittiness, but possessing no superiority over 
prepared chalk. 

Creta Praeparata [Prepared Chalk) (CaC0 3 ) is made from chalk 
or whiting by levigation and elutriation. It occurs in little white 
conical loaves, which are tasteless, odorless, insoluble in water, but 
soluble in carbonic acid water. 

Effects and Uses. — Its effects are those of an antacid and 
desiccant-astringent. It is prescribed in dyspepsia and gout attended 
with an excess of acid in the system; also in diarrhoea; and as it 



484 MATERIA MEDICA AND THERAPEUTICS. 

forms soluble calcium salts with the acids of the stomach, its em- 
ployment has been suggested in rachitis. 

Administration. — Dose, gr. x-xxx, in powder or suspended 
in water with gum and sugar. Pulvis cretce compositus (compound 
chalk-pozvder) is made by mixing prepared chalk (30 parts) with 
powdered acacia (20 parts), and sugar (50 parts). Mistura cretce 
(chalk-mixture) consists of compound chalk-powder (20 parts) 
mixed with water and cinnamon-water (40 parts of each) ; dose, 
foss, repeated. Laudanum and tincture of kino or of catechu, and 
aromatics, are often added to this mixture in the treatment of acute 
diarrhoea. Troches of chalk are made by mixing prepared chalk, 
acacia, nutmeg and sugar, and forming a mass with water ; each 
troche containing gr. iv of prepared chalk. 

CALCAREOUS WATERS— NORTH AMERICAN. 

Catoosa Springs (Catoosa County, Georgia) contain calcium 
sulphate gr. 39, with magnesium sulphate and carbonate gr. 34, 
and carbonic acid gas gr. 4^ to the gallon. 

Tate Epsom Springs {Granger County) Tennessee). Calcium 
sulphate is the chief ingredient, gr. 160 to the gallon; also Epsom 
and common salt. Temperature, 55 Fahr. 

CALCAREOUS WATERS— EUROPEAN. 

Contrexville and Bagneres-de-Bigorre (France), Leuk (Switzer- 
land), and Wildungen (Germany). The most important ingredients 
in these waters are calcium carbonate and sulphate with small quan- 
tities of iron carbonate and carbonic acid gas. Their temperature 
varies, Contrexville being 54 Fahr., and Leuk, the highest, 123 
Fahr. The Contrexville water is highly diuretic and diaphoretic, 
producing some phenomena of excitement. It is particularly use- 
ful in the uric acid diathesis, gravel, renal calcidi and chronic cystitis. 
Their good effects seem to be due to a thorough flushing out of 
the urinary apparatus more than to anything else. The waters of 
Bagneres-de-Bigorre are reputed sedative in nervous conditions ; 
but the fresh mountain air of the neighborhood may have some- 
thing to do with it. Those of Leuk, which on account of their 
high temperature act freely on the skin, are employed in the form 
of baths for the treatment of cutaneous maladies as lichen, chronic 
eczema, psoriasis and phthiriasis. The Wildungen water is used in 
the same affections as the Contrexville. 



ANTISEPTICS AND ANTIPYRETICS. 485 

CLASS IV.— TOPICAL MEDICINES. 

ORDER I.— ANTISEPTICS AND ANTIPYRETICS. 

Antiseptics (dun, against, and <jy)7tt6<;, putrid) are remedies 
which prevent fermentation and decomposition by a poisonous 
influence on the protoplasmic germs on which those processes 
depend, while antipyretics (dyrc, against, and 7rEy>£r6c, fever) are 
those which reduce the temperature of the body, such action being 
particularly conspicuous when the body heat is elevated by a 
febrile process, and almost nil in the normal state. 

The antiseptic and the antipyretic properties of many sub- 
stances of this group bear a definite relation to each other, so that 
they are powerful in lowering febrile temperatare in the same ratio 
as they are destructive to lower forms of life, and especially is this 
the case with the lower members of the aromatic series of carbon 
compounds. 

The theory of putrefaction which, based upon the researches 
of Pasteur, has been steadily gaining ground and is now almost 
universally adopted, refers the changes which take place in decom- 
posing matter to the agency of organized germs ever present in the 
atmosphere, which, finding a suitable nidus in putrescible material, 
grow and multiply, producing chemical decomposition as a result 
of their presence. As in many diseases (e. g., relapsing fever, diph- 
theria, etc.) certain organized germs have been found to take an es- 
sential part in the diseased process, if not to produce it, and as their 
presence is suspected in many diseases in which as yet they have 
not been demonstrated to exist, the importance of a group of agents 
which are destructive to these low forms of life can hardly be exag- 
gerated. The extent to which this group of remedies will destroy 
disease-germs in the body without injuring the vitality of the hu- 
man being, cannot be definitely laid down. Certain it is that as yet we 
possess very few specifics in medicine, especially against the zymotic 
diseases, which would appear a priori to be especially the class to 
which antiseptics would apply. Yet as many antiseptics are also 
antipyretics, they are not without use in the diseased economy, even 
if they do not cut short the morbid process. 

When applied topically antiseptics are of great value, not only 
as deodorants and disinfectants, but also as germicides in dressing 



486 MATERIA MEDICA AND THERAPEUTICS. 

wounds, ulcers, etc., as in Sir Joseph Lister's antiseptic method 
or its various modifications. They are also useful to prevent the 
spread of disease when added to the excreta of patients suffering 
from contagious affections. 

Antipyretics act* chiefly either to lessen the production of heat 
by retarding oxidation, and consequently cell-proliferation and 
chemical and molecular changes in the tissues, or by depressing the 
circulation either of the part (local abstraction of blood, blisters, 
etc.), or of the system at large (sedatives) ; or increase the loss of heat 
by increasing the evaporation of perspiration from the surface (dia- 
phoretics) ; by dilating the cutaneous vessels and thus promoting 
heat-radiation (alcohol, amyl nitrite, spirit of nitrous ether), or by 
abstracting heat directly from the surface (cold applications of 
drinks). Many of the antipyretics (e.g., sedatives, sudorifics, quin- 
ine, etc.), as well as of the antiseptics (alcohol, iodine, quinine and 
solutions of various metallic salts), have already been discussed, and 
it now remains to study those articles of the former group which 
are used to lessen heat production chiefly by retarding oxidation, 
as well as those remedies particularly employed as topical antisep- 
tic agents. 

POTASSII PERMANGANAS— POTASSIUM PERMANGANATE. 

Preparation and Description. — This salt is made by mixing 
together equal parts of manganese dioxide and potassium chlorate, 
dissolving in a little water, evaporating to dryness, and exposing to 
a nearly red .heat. Potassium permanganate (K 2 Mn 2 8 ) occurs in 
the form of slender prismatic crystals of a deep purple color, in- 
odorous and of a sweetish, astringent taste. It dissolves readily in 
water, making a beautiful lilac-solution, which is readily decolorized 
by Fowler's arsenical solution and organic matters. 

Effects and Uses. — There is little experience as regards the 
action of this salt when administered internally, although alterative 
effects are attributed to it (and probably with reason) in poisoned 
conditions of the blood, as in malignant fevers, diphtheria, pyemia, 
erysipelas, puerperal fever, etc. It is also used with success in 
ameiiorrhcea (Ringer), especially when of a purely functional char- 
acter. It may be administered in gelatin-capsules; dose, gr. j-ij 



* " A Text-book on Pharmacol., Mat. Med. and Therapeut." London, 1885, PP- 53 
and 366. By T. Lauder Brunton. 



ANTISEPTICS AND ANTIPYRETICS. 487 

t d., taken for five days or a week before the expected period. 
It is, however, as a powerful disinfectant that it now claims chief 
attention, and it now ranks at the head of this class of agents in de- 
stroying fetid odors and poisonous organic emanations. Its power 
in this respect is due to the evolution of oxygen in its more active 
form, ozone. 

It is used externally in dressing foul and fetid or gangrenous 
ulcers, particularly those of hospital gangrene, as an application to 
carbuncles, as a gargle in diphtheria, as an injection into the cavity of 
abscess, and bubo, and injected into the wound caused by the bites of 
insects or venomous snakes. It may be sprinkled in powder on gan- 
grenous surfaces, phagedena, or applied in solution of the strength 
of 5^j-ij to a pint of water. As a disinfectant and deodorizer, a 
solution of from one to ten grains to an ounce of water may be 
exposed in saucers or sprinkled on the floor, or thrown into the air 
in spray by the atomizer. 

Administration. — One to three grains may be given internally 
made into pills with cacao-butter and vaseline, or taken in gelatin- 
capsules through the day. Condys Fluid contains gr. ij to the foj. 
It is used for a variety of purposes where a disinfectant and deodor- 
izer are indicated, as bedsores, a wash in ozcena, a mouth-wash in 
sordes, fetor of the breath, and to correct fetor of the feet. As an in- 
jection in gonorrhoea potassium permanganate (gr. ij to water f §j) is 
highly efficacious, especially where a profuse yellowish discharge 
exists. In using this remedy, care must be taken to avoid the intro- 
duction of organic matter into the solution, which, by reducing the 
salt to an oxide, will destroy its efficiency. A good plan is to 
make the solution as required. Milton* states that nothing ap- 
proaches it in point of efficiency as an injection in gonorrhoea. In 
the same way it may be employed in gonorrhoea of the female and 
urethritis. 

AQUA CHLORI— CHLORINE- WATER. 

This is an aqueous solution of chlorine, and should be kept in 
a cool place, protected from the light, but it is soon decomposed. 
It contains at least 0.4 per cent, of the gas. It occurs as a green- 
ish-yellow liquid, having an astringent taste and the suffocating 
odor of the gas. 



* " On Gonorrhoea/' etc., 1887, p. 201. 



488 MATERIA MEDIC A AND THERAPEUTICS. 

Effects and Uses. — Chlorine acts as a disinfectant and de- 
odorizer, chiefly by its affinity for the hydrogen of moisture and the 
liberation of oxygen ; its gaseous form gives it advantages in this 
respect. It is seldom used internally, but has been employed in 
essential malignant fevers, as scarlatina and typhus, and as an anti- 
dote for hydrocyanic acid. Externally it is used, diluted, as a wash 
in skin-diseases, as an antiseptic, and by inhalation in bronchial 
affections. Solutions containing chlorine and other antiseptics are 
useful applications to suppurating surfaces, by preventing the de- 
composition of pus, and thereby pyemia. In case of poisoning 
by chlorine-water, albumen is the best antidote. Dose, f3j-iv, 
diluted. 

CALX CHLORATA— CHLORINATED LIME. 

Preparation and Description. — This agent, often called chlo- 
ride of lime, is prepared by passing chlorine over calcium hydrate 
till saturation is effected, and is said to be, principally a mixture of 
calcium hypochlorite and chloride (CaCl 2 2 and CaCl 2 ). It occurs 
as a loose, grayish-white powder, or friable lumps, dry or but 
slightly moist, readily soluble in water, of a bitter, caustic taste and 
a faint odor of chlorine. Exposed to air and moisture, it slowly 
yields hypochlorous acid (HCIO), and this soon breaks up into 
water, chloric acid (HC10 3 ), and free chlorine, and the chloric acid 
again yields chlorine; 25 per cent, of chlorine should be furnished 
by good chlorinated lime. 

Effects and Uses. — Its effects are essentially those of chlo- 
rine, like which it decomposes sulphuric and hydrocyanic acids, and 
should not be given with the mercurials, or carbonates. It has been 
used as an alterative in typlius, malignant scarlatina, etc., in doses of 
gr. j-v, in solution, several times a day; and as a wash, externally, 
one part dissolved in a hundred parts of water ; or as a paste. It is 
chiefly, however, as a disinfectant that it is employed. 

Liquor Sodee Chloratas [Solution of Chlorinated Soda) (NaCl,- 
NaClO), sometimes termed Labarraque s Disinfecting Liquid, 
is made by decomposing a solution of sodium carbonate by 
one of chlorinated lime. It is a transparent, greenish-yellow 
liquid, with a faint smell of chlorine, a sharp saline taste and an 
alkaline reaction. It has been used internally, to fulfill the same 
indications as chlorinated lime, in dose of Tftx-f5j, diluted, several 
times a day. It is useful, also, in dilution of various strengths, as 



ANTISEPTICS AND ANTIPYRETICS. 489 

an external application to every form of fetid ulcer, as a mouth-wash 
in mcrcurialismus, and is a most valuable and powerful disinfectant. 

Hydrargyri Chloridum Corrosivum (Mercuric Chloride). 

Effects and Uses. — Corrosive sublimate (q. v.) is very de- 
structive to the lower forms of life, and is largely used for this pur- 
pose in the treatment of various surgical affections. It is employed 
in solutions (i to iooo, - I to 8000) as a prophylactic to cleanse 
the surface of the patient, and the hands, instruments, and sponges 
of the surgeon, previous to an operation, and in the form of cor- 
rosive sublimated gauze, or cotton, as a dressing after the operation 
is finished, and thus prevent the entrance of the germs on which 
depend suppuration, erysipelatous, or diphtheritic inflammation, and 
other complications of wounds. 

To destroy germs when already present, it is also useful. Thus, 
in the treatment of abscesses, either acute or chronic, after evacuating 
the contents through a small incision, the cavity should be super- 
distended with the corrosive sublimate solution (1-1000 or 1-2000) 
and the fluid retained from two to five minutes, when it should be 
allowed to drain off, after which the injection is to be repeated until 
the fluid flows away as clear as when introduced. In this way we 
destroy the protophytes on which these forms of suppuration de- 
pend, and thus hasten the growth of granulations. In psoas, iliac 
or lumbar abscess this method of treatment probably gives the best 
results, and deep-seated mammary abscesses may be rapidly healed 
by its employment. 

As numerous cases of poisoning are recorded, it is better to 
decrease the strength of the solution or to discontinue its use, and 
employ pressure to bring the walls of the abscess together, after a 
few days, when healthy granulations are springing up. 

As an injection in gonorrhoea, a weak solution (1-8000, or bet- 
ter, 1-12,000) may be used to destroy the gonococci, but even then 
severe pain and violent inflammation may be excited in the male 
urethra by such an injection. In gonorrhoea of the female, a cor- 
rosive chloride solution (1-8000) thrown into the vagina when the 
patient is in the recumbent position with the hips slightly elevated 
by a pillow is very efficacious. 

In the treatment of puerperal septicemia, vaginal and even 
uterine injections are employed, care being taken in the latter case 
to throw the solution very slowly into the uterus, to be sure that 



490 MATERIA MEDICA AND THERAPEUTICS. 

it returns freely through the os uteri, to avoid the introduction of 
air into the uterus and to discontinue the injection should much 
pain be complained of or symptoms of syncope or collapse super- 
vene. 

It may be used not only as a dressing but also as a wash for 
all wounds and ulcers whatever. 

Administration. — A solution of the required strength may be 
made as follows : 1^ Hydrargyri chloridi corrosivi, 5j ; divide in 
chart vnj. Sig. — One powder dissolved in a pint of hot water forms 
a solution of I to iooo; or, as the powders are somewhat difficult 
of solution, Ify Hydrargyri chloridi corrosivi, 5j : alcohol, fSij. 
M. Sig. — f5ij, in a pint of water = I in iooo parts. If the latter 
solution is to be kept for some time, it is well to add an equal 
weight of ammonium chloride to the corrosive sublimate to pre- 
vent the decomposition of the latter salt. 

Compressed tablets are also kept in the shops, which are very 
convenient for making solutions. If mercuric chloride be used to 
disinfect instruments, they should not, be allowed to remain in the 
solution, as otherwise mercury will be deposited on the surface of 
the metal, and the instrument tarnished. Gauze, lint, cotton, wool, 
jute, saw-dust, etc., are impregnated with solutions of corrosive 
chioride and used as surgical dressings. 

Bromine (see Escharotics) and Iodine are antiseptics, acting in 
a manner similar to chlorine. They are seldom used for this 
purpose. 

Hydrargyri Iodidum Rubrum [Mercuric Iodide) (q. v.) is also 
used in aqueous solution as an antiseptic (i to 2000). It has not, 
however, replaced the mercuric chloride as a germicide. 

Acidum Sulphurosum (Sulphurous Acid) contains about 3.5 per 
cent, of sulphurous acid gas in distilled water, and is made by heat- 
ing sulphuric acid with charcoal and distilled water. The sulphuric 
acid is deprived of an equivalent of oxygen by the charcoal, and 
becomes sulphurous acid (H 2 S0 3 ). It is a colorless liquid, having 
the smell of burning sulphur and a sulphurous, sour, and some- 
what astringent taste. 

Effects and Uses. — It is a powerful deoxidizing agent, very de- 
structive to vegetable life, and is believed to exert a similar influence 



ANTISEPTICS AND ANTIPYRETICS. 491 

on disease-germs. It is readily absorbed by the stomach, and is 
eliminated by the urine and feces as a sulphate. Internally, it is very 
efficacious in sarcina ventriculi, or yeast vomiting; dose, f5j, largely 
diluted with water. Externally, it is used in skin-diseases of a par- 
asitic nature, as tinea circinata and versicolor and f emits, mopped on 
pure or diluted with two or three measures of water or glycerin. 
When the attacked parts are exposed, the face or neck for example, 
it possesses the advantage of not leaving a temporary stain. 

Sodii Sulphis {Sodium Sulphite) (Na 2 S0 3 .7H 2 0) is used as a 
substitute for sulphurous acid, which is developed from the salt by 
any of the organic acids. It occurs in white, efflorescent, prismatic 
crystals, of a sulphurous taste, soluble in four parts of cold and one 
part of boiling water. 

Administration. — Dose, 5j, three times a day; a solution 
(5j-f5j of water) is a good local application in erysipelas and aphthce. 

Sodii Bisulphis {Sodium Bisulphite) (NaHS0 3 ) occurs in 
opaque, prismatic crystals or a crystalline or granular powder, 
slowly oxidizing and losing sulphurous acid on exposure to air, hav- 
ing a faint sulphurous odor and taste, soluble in 4 parts of cold and 
2 parts of boiling water. 

Effects and Uses, — It is used as a substitute for sodium sul- 
phite, to which it is preferred because of the greater proportion of 
sulphurous acid which it contains. Dose, gr. v-xx. 

Sodii Hyposulphis {Sodium Hyposulphite) (Na 2 S 2 3 . 5H 2 0) is 
used for the same purposes. It occurs in white, tabular crystals, 
of a pearly lustre and sulphurous taste, which are efflorescent, and 
very soluble in water and alcohol and insoluble in ether. Dose, 
gr. x-xx three times a day, and for external use, 5j dissolved in 
water fgj. 

Potassii Sulphis {Potassium Sulphite) (K 2 S0 3 .2H 2 0) occurs in 
white, opaque fragments or powder, of a saline and sulphurous 
taste, very soluble in water ; its uses and doses are the same as 
those of sodium sulphite. 

Magnesii Sulphis {Magnesium Sulphite) (MgS0 3 .6H 2 0) is also 
employed in zymotic diseases and in flatulent dyspepsia, to prevent 



492 MATERIA MEDICA AND THERAPEUTICS. 

the formation of gases in the alimentary canal. It is less unpala- 
table than the sodium salt, and besides contains a larger propor- 
tional quantity of acid. The sodium, potassium, and magnesium 
sulphites are employed in the treatment of purulent infection. 
Calcium and ammonium sulphites have been also recommended, but 
are not official. 

The Sulphides appear to possess the power of checking the 
formation of pus. On this ground they are highly lauded in boils, 
abscesses, carbuncles, etc., by Dr. Ringer. 

Calx Sulphurata {Sulphurated Lime) often misnamed calcium 
sulphide, consists chiefly of a mixture of "calcium sulphide and 
calcium sulphate in varying proportions, but containing not less 
than 36 per cent, of absolute calcium sulphide." It is recommended 
to check the formation of pus, in doses of gr. T V every hour. In 
eight cases of chancroidal bubo I found the use of calcium sulphide 
of doubtful service in promoting their resolution. The dose em- 
ployed was gr. \~y 2 t. d. (C. B.). 

ACIDUM BORICUM— BORIC ACID. 

Preparation and Description. — Boric or Boracic Acid 
(H3BO3) exists in nature in volcanic regions, notably in Tuscany. 
In this region, which was formerly the main source of supply of 
this acid, jets of steam, called suffioni, escape through fissures in the 
hillsides, and are made to pass through a series of shallow basins 
along which water is slowly flowing. The water becomes charged 
with boric acid, which is converted into borax. A boiling concen- 
trated solution of borax is slowly decomposed with an excess of 
sulphuric acid, and on cooling, boric acid is obtained in transparent 
six-sided crystalline plates, unctuous to the touch, odorless, slightly 
bitter, soluble in cold water, more so in alcohol and very soluble in 
boiling water. The supply to the United States is now derived 
almost exclusively from Borax Lake in California, about one hun- 
dred miles north of San Francisco. 

Incompatibles. — With the carbonates and bicarbonates, car- 
bonic acid is liberated ; with the alkaline, earthy and metallic bases, 
borates are formed. 

Physiological Effects. — Boric acid is antiseptic and deodor- 
ant, arresting fermentation and proving very poisonous to the lower 
forms of life. Neumann found by experiments on dogs, verified on 



ANTISEPTICS AND ANTIPYRETICS. 493 

rabbits and young pigs, that boric acid caused a decided fall in the 
temperature of the body, while large doses produced diarrhoea and 
vomiting. Three per cent, solutions injected into the serous 
cavities caused no inflammation, but when large amounts were 
injected the animal died from paralysis of the motor-nerves and 
muscles.* 

According to J. Forster,f boric acid augments the amount of 
nitrogen and of solid matter excreted by the feces, the increase be- 
ing in direct proportion to the amount of the drug ingested. As 
small a dose as gr. vij daily will produce these effects. 

Toxicology. — Mododewkow reports two fatal cases of poison- 
ing with boracic acid. In one case a pleuritic cavity and in the 
other a lumbar abscess was washed out with a five per cent solu- 
tion of the acid, some of which remained in both cases. The 
symptoms were, persistent vomiting, hiccough, erythema beginning 
on the face, slight temporary rise of temperature, diminished car- 
diac power ending in paralysis. He suggests morphine and stimu- 
lants in like cases. % 

Medicinal Uses. — This medicament is. rarely used internally, 
though Mr. Perez § recommends the internal use of boracic acid 
(gr. x, omn. trihor.) to prevent the formation of ammoniacal urine 
in the bladder in cases of chronic cystitis ; and as it is said to pass 
through the kidneys unchanged, it is recommended as an antiseptic 
in pyelonephritis. 

Boric acid is used externally as an antiseptic in the treat- 
ment of wounds , burns ; ulcers, abscesses, phlegmonous erysipelas, 
acute eczema, etc. In these affections a saturated aqueous solu- 
tion may be applied on sterilized cotton or gauze; in abscess 
after evacuation it should be injected into the cavity, gr. x-xx to 
water foj. A saturated solution is a good deodorizing application 
to correct fetor of the feet. It has also been used with advantage in 
inflammation of the mucous membranes, as aphtha, gingivitis, 
diphtheritic inflammations of the mouth, etc., in the form of a gargle 
dissolved in water and glycerin. It may be dusted into the exter- 
nal auditory meatus in otorrhcea attended with suppuration. The 
parts should first be cleansed with tepid water, then dried, and the 



* N. Y. Med. Jour., Jan. 27th, .1863, quoted from Lancet. 

f Dingl's Polytechnik Journ., No. CCLI, p. 170. 

% Wratch, No. 31, 1881. § Lancet, July, 1884, p. 133. 



494 MATERIA MEDICA AND THERAPEUTICS. 

acid introduced by insufflation and retained by a cotton-plug. The 
same method of treatment is appliable to myringitis. It has been 
applied with advantage in inflammation of the conjunctiva (gr. v-x 
to aq.foj). Used as an injection, it appears to shorten the duration 
of gonorrhoea. Made into an ointment with vaseline or cerate (gr. 
x-xx to oj) it is an excellent antiseptic dressing for wounds. This 
form may be applied to the eye-lids in blepharitis, and to fissure of 
the nipple. 

S0DI1 BORAS— SODIUM BORATE. 

Sodium Borate or Borax occurs as a native product in several 
localities, the most important of which for a long time was Thibet, 
in Asia ; it is also made artificially by the direct combination of 
native boric acid with soda. Borax (Na 2 B 4 7 .ioH 2 0) occurs in the 
form of hexahedral prismatic crystals, terminated by triangular 
pyramids, of a sweetish alkaline taste and an alkaline reaction. It 
is wholly soluble in water, slowly effloresces, and possesses the 
property of rendering cream of tartar very soluble in water. 

Incompatibles. — The mineral and vegetable acids decompose 
borax. With morphine and cocaine salts a precipitate goes down. 

Effects and Uses. — Borax is a mild refrigerant and diuretic, 
and locally an antiseptic, and has emmenagogue virtues attributed 
to it. 

It has been given in infantile diarrhoea as an enema, and is used 
externally in cutaneous affections (5j to water Oj as a wash in 
pruritus and in acne punctata), but especially as a detergent in aph- 
thous affections of the mouth in children, mixed with an equal 
quantity of sugar. 

A piece of borax slowly dissolved in the mouth will often cure 
acute hoarseness. Glycerite of sodium borate may be made by 
rubbing up sodium borate gij in glycerin Oss ; honey of sodium 
borate may be made by mixing 5j with clarified honey, f§j. These 
preparations are used chiefly as applications to the mouth and 
throat. Dose, gr. xxx. 

DERIVATIVES OF THE ORGANIC RADICAL PHENYL. 

The eager search after a remedy which will replace quinine, 
has, within the last few years led to the discovery of medicinal 
qualities, hitherto undreamed of, in various chemical substances, 
particularly with regard to certain members of the aromatic series of 
the carbon compounds. While the remedies heretofore discussed 



ANTISEPTICS AND ANTIPYRETICS. 495 

under the head of antiseptics are chiefly used externally for their ac- 
tion as protoplasmic poisons, the group about to be studied are used 
internally for their antipyretic properties, and though most of them 
are also antiseptic, yet the latter action appears to be readily modi- 
fied by slight changes in certain members of the group. Thus, 
while salicylic acid is antiseptic, its salts do not possess this prop- 
erty, and its isomers — meta- and para-oxybenzoic acids — have no 
such power. 

As some knowledge of their chemical constitution is essential 
to the proper understanding of the relations existing between mem- 
bers of this group, a few remarks bearing on this subject will not be 
out of place here. 

Phenyl, the organic radical of this group, consists of carbon 6 
atoms united with hydrogen 5 atoms, the elements being arranged, 
according to the theory of Kekule, on which alone is it possible to 
explain the formation of its derivatives, in such a manner that the 
C. elements are united in a closed chain, exchanging with each 
other alternately one and two valences, and as C. is a tetrad, each 
with one exception, which is unsatisfied, is likewise joined to the cor- 
responding element H., thus — 

I 
H C H 

\ ^i\ / 

C6 2C 

I II 

C5 3C 

/ %4^ \ 

H C H 

I 

H 
(Phenyl.) 

Should the unsatisfied atom of C. become saturated with H., phenyl 
hydride, benzine or benzol (C 6 H 6 ), is formed. The atoms of H. in 
phenyl hydride may be displaced by other univalent elements or 
radicals and substitution compounds constructed : thus should one 
atom of H. be. displaced by hydroxyl (HO), phenol or carbolic acid 
(C 6 H 6 HO) is produced; should nitroxyl (N0 2 ) displace an H. atom 
of phenyl hydride, nitro-benzine (C 6 H 5 N0 2 ) results ; if amidogen 
(NH 2 ) replace an H. atom, aniline (C 6 H 5 NH 2 ) is formed, and if car- 
boxyl (COHO) take the place of H., the product is benzoic acid 
(QH 6 CO.OH). 

Di-derivatives containing two atoms of the same element or 



.496 MATERIA MEDICA AND THERAPEUTICS. 

radical, are capable of three isomeric modifications, according as the 

replaced H. atoms are those numbered 1.2. or 1.3. or 1.4. in the 

above graphic formula, which isomers take the prefix ortho-ox meta- 

ox para- to distinguish them; thus, should hydroxyl displace 2H. 

atoms in phenyl hydride, one of 3 compounds may result — ortho- 

oxyphenol ( pyrocatechin), meta-oxyphenol (resorcin), or para-oxy- 

phenol (hydroquinone), all of which have the common formula C 6 H 4 - 

(HO) 2 ; or should hydroxyl and carboxyl be the replacing radicals, 

ortho-benzoic acid [salicylic acid), meta- or para-benzoic acid may 

result, the formula for each of which is the same — C 6 H 4 HO.COOH. 

The carbon chains of the phenyl hydride group may join with 

similar chains, thus — 

H H 

I I 

H C C H 

\/ \ / \ / 

c c c 

I II I 

c c c 

/ % / N / \ 

H C C H 

I " I 

H H 

(Naphthaline.) 

giving rise to an homologous series, benzene (C 6 H 6 ) being a single 
link, 2 links united forming naphthaline (C 10 H 8 ), 3 links anthracene 
(C 14 H 10 ), etc. 

The carbon atoms of phenyl hydride may be replaced by other 
elements; thus, if the triad N. take the place of a C. atom in the 
chain, pyridine (C 5 H 5 N) results. The carbon chains of the benzene 
and pyridine groups may unite with the production of chinoline 
(QH 7 N), 

H H N— H 

1 r <r.i 

HCNH HCNH 

c c c c c c 

I II I I II I 

c c c c c . c 

HCCH HCCHH 

II IN 

H H H H H 

(Chinoline.) (Chinocine or Quinocine.) 

or by a modification in the arrangement of valences of the pyridine 
link in chinoline, it is enabled to unite with more H. and N., forming 



ANTISEPTICS AND ANTIPYRETICS. 497 

chifiocinc or quinocinc (C 9 H 10 N 2 ), and from these are obtained several 
important salts, as Kairin (oxyethyl-chinoline hydride hydrochlo- 
rate), tliallin (tetrahydroparamethyloxychinoline) and antipyrine 
(dimethyloxychinoci ne). 

Phenyl hydride, benzine or benzol is only of interest in medicine 
from a toxicological point, several cases of poisoning from it having 
been reported,* and from the fact as shown by Filehne,f that its de- 
rivatives, benzyl-tr opine, benzyl-quinine ', etc., are local anaesthetics of 
considerable power. 

ACIDUM CARBOLICUM— CARBOLIC ACID. 

This substance, termed also phenol, phenic acid, or phenyl hy- 
drate, is a product of the distillation of coal-tar oil. 

Preparation. — Crude Carbolic Acid {Acidum Carbolicum 
Cruduni) is made by treating the impure coal-tar of commerce with 
a saturated solution of potash, when it is resolved, on the addition 
of water, into a light oil and a heavier alkaline liquid ; the latter is 
separated and neutralized with hydrochloric acid, and the impure 
carbolic acid, which is disengaged, is afterward distilled from dried 
calcium, to remove water, when upon exposing the distillate to a 
low temperature, carbolic acid congeals in the form of a colorless 
crystalline mass. Recently a pure synthetic phenol has been 
placed on the market. 

Chemistry. — In its pure state it is solid at ordinary tempera- 
tures, crystallizing in long rhomboidal needles, white or colorless, of 
a peculiar empyreumatic odor like unto (but not identical with) that 
of creasote, and an acrid, burning taste; if even slightly impure, it 
has a reddish color, or will acquire it on exposure. Although it 
combines with salifiable bases, it does not act as an acid upon colors, 
and is chemically phenyl hydrate (C 6 H 5 HOj. Its sp. gr. is 1.065; 
it deliquesces readily and assumes the liquid state in the presence of 
a little water, without dissolving in it. 

When quite pure it melts at 160 F., forming an oily-looking, 
colorless liquid, which boils at 359 F. It is soluble in 20 parts of 
water, and very soluble in alcohol, ether, acetic acid, glycerin (com- 
mercial and absolute) and in the fixed and volatile oils. 

Tests. — Carbolic acid may be recognized by the following 

* Annates d? Hygiene, 1883, p. 426, MM. Neumann et Pabst. 
| Berlin Klin. Wochensch., No. 7, 1887. 
32 



498 MATERIA MEDIC A AND THERAPEUTICS. 

tests: " ist, by its peculiar smell; 2d, by the formation of yellow 
picric acid, with nitric acid of 36 B.; 3d, by the production of a 
blue or green color when treated with a small quantity of am- 
monium hydrate and a trace of a solution of a hypochlorite" (Sal- 
kowski's test); "4th, by a lilac color produced on the addition of a 
small quantity of ferric sulphate ; 5th, by a yellowish-white precipi- 
tate with bromine water" (Witthaus*). 

The last three tests are very delicate. 6th. The most delicate 
test is that suggested by Plugge : " When a liquid containing car- 
bolic acid is boiled with a little solution of mercurous nitrate con- 
taining a trace of nitrous acid, a reduction of the mercurous salt 
takes place and the liquid becomes of an intensely red color." 
This test is said to detect 1 part of carbolic acid in 200,000. Car- 
bolic acid in solution coagulates albumen and precipitates nitro- 
cellulose from collodion, which distinguishes it from creasote. 

Incompatibles. — With the alkalies and alkaline earths car- 
bolates are formed ; mixed with bromine a white precipitate goes 
down. It is also incompatible with antipyrine, collodion and the 
metallic salts. 

Aids. — Creasote and the phenol derivatives. 

Physiological Effects. — Carbolic acid is a protoplasmic 
poison, destructive to all forms of life, whether vegetable or animal. 
Topically. — When applied to the skin it produces a white super- 
ficial eschar, becoming brownish. When applied in a concen- 
trated form it causes very great local anaesthesia, extending inward 
for some depth to the tissues with which the acid has not come 
in contact. 

Internally. — Carbolic acid in medicinal doses produces a 
rather cooling, sedative effect upon the stomach and it probably 
enters the blood as an alkaline carbolate. Nervous system : after 
poisonous doses have been given to animals, there is paralysis of 
the posterior extremities, extending to the anterior, and finally reflex 
tetanic convulsion. In man a poisonous quantity produces vertigo, 
contracted pupils, and stupor with sometimes tremors, never, 
however, amounting to convulsions, as in the lower animals. The 
convulsions are probably of spinal origin — certainly not peripheral. 
The reflex activity is at first increased, then abolished. The 
nerves and muscles are not paralyzed, but after death they are 

* General Med. Chemistry. By R. A. Witthaus, A. M., M. D. 



ANTISEPTICS AND ANTIPYRETICS. • 499 

found to be more readily exhausted than normal. Circulation : 
the heart is at first depressed, afterwards accelerated (caused by 
stimulation and exhaustion of the vagi). In slow cases of poison- 
ing, death is produced by diastolic arrest. The arterial pressure is 
reduced on account of the paralysis of the vaso-motor centre of the 
cord. Dr. Prudden* has shown that in strong solution it paralyzes, 
while in weak solution, it renders sluggish the movements of the 
white corpuscles in frogs. Respiration is affected early in the 
poisoning, the movements being much increased in frequency but 
very shallow ; this increase is due to stimulation partly of the peri- 
pheral vagi and partly of the respiratory centre (Salkowski). 
Temperature is somewhat reduced. Elimination takes place by all 
the secretions, especially by the urine, saliva and breath. When a 
small amount only is taken, it is probably all excreted as an alka- 
line carbolate ; but when the amount is larger, a portion is oxidized 
in the system and escapes under different forms, especially as oxalic 
acid in the urine. These products of oxidation generally color the 
urine dark brown or black, and as this is one of the first signs of 
poisoning, the urine should always be watched when carbolic acid 
is being administered or when it is applied to a large surface. 

Toxicology. — Andersonf reports a case in which 5j of the 
pure acid killed an adult in twelve hours, with symptoms of acute 
gastritis ; and HearderJ one in which a man died in thirty minutes 
after swallowing §j. The external application, too, of carbolic acid 
has destroyed life. 

Post-mortem appearances : after death from a concentrated 
solution of the acid, hard, white, dry spots surrounded by a circle 
of inflammation are found on all the mucous membranes, particu- 
larly visible about the lips and fauces, with which the acid has come 
in contact, even as far down as the intestines in some instances. 
All the viscera are filled with dark, imperfectly-coagulated blood, 
and sometimes there is fatty degeneration of the liver and kidneys. 

Antidotes. — As a chemical antidote in cases of poisoning a 
saturated solution of calcium saccharate has been recommended. 
To evacuate the stomach the stomach-pump should be used, since 
the benumbing influence of the poison hinders the action of emetics. 



* Amer. Jour. Med. Set., Jan., 1881. 
f The Lancet, Jan., 1869, p. 179. 
%Brit. Med. Jour , May, 1873, p. 584. 



500 MATERIA MEDIC A AND THERAPEUTICS. 

Demulcents should be given, but not oils, as it is soluble in them. 
By forming salts with the alkalies its poisonous action is to a cer- 
tain extent neutralized, hence their exhibition is called for. Atro- 
pine is the physiological antagonist of carbolic acid; enough should 
be given to counteract the depressing effect of the acid upon the 
respiration and circulation, and diluents should be freely adminis- 
tered to aid in its elimination (A. C. Post). 

Medicinal Uses. — Carbolic acid is used internally to check 
vomiting where the stomach is irritable and nausea a constant 
symptom, the dose to be small and taken every 3 or 4 hours ; as an 
antifermentative in eructations; as a local intestinal astringent in 
chronic diarrhoea; to destroy the germs of sarcina ventriculi ; as an 
anthelmintic against ascarides and tcenia solium ; and as an antisep- 
tic in certain zymotic diseases, particularly small pox, typhoid fever, 
scarlatina, erysipelas, diphtheria, etc. According to Rothe, this 
agent seems to lower the fever and lessen the diarrhoea of typhoid. 
It has also been given internally with some success in cholera and dia- 
betes mellitus, and combined with iodine in chronic malarial cachexia it 
is highly recommended. Carbolic acid spray is used as an inhalation 
in chronic nasal catarrh, hay-fever, chronic bronchitis, whooping- 
cough, phthisis, gangrene of the lungs, etc., with a view of destroy- 
ing germs, stimulating the mucous membrane to healthy action and 
to correct the fetor. 

By Injection. — Deep-seated injections into the tissues of a 
two per cent, solution of carbolic acid, as recommended by Hiiter, 
have been practiced with success in erysipelas (Aufrecht), abscesses, 
etc., and are thrown into the cavity of joints in synovitis, and into 
bursce in ganglion, etc. Extraordinary care must be taken not to 
inject the acid into a blood-vessel. 

Dr. R. J. Levis has injected pure carbolic acid (the crystals 
liquefied by heat) 5ss-j into the sac of the tunica vaginalis after evac- 
uating its contents, for the radical cure of hydrocele. This treatment 
is followed at the Out- Patient Surgical Department of the Jefferson 
College Hospital with almost unvarying success. Dr. S. W. 
Gross* has collected 90 cases of hydrocele treated by the carbolic- 
acid method, all of which were successful, though suppuration en- 
sued in three. It is occasionally injected into hemorrhoidal tumors 
for the cure of piles, but it is not altogether a safe remedy, and 

* Med. Times, April, 1888, p. 384. 



ANTISEPTICS AND ANTIPYRETICS. 501 

by enemata into the rectum; (gtt. vj to water Oj), against thread- 
worrns. 

External Uses. — As an external application its uses are 
still more important. In the concentrated form it is employed as 
a cauterant in condylomata, chancroids, lupus, etc., and to produce 
local anaesthesia for minor surgical operations as the opening of 
abscesses, felons, etc., and in various forms of dilution in cutaneous 
eruptions of parisitic origin as tinea circinata, and capitis, favus, 
etc., to the pustules of acne in full strength ; in the form of ointment 
as an antipruritic remedy to pruritus ani and other parts, to allay 
the itching of acute eczema and prickly heat applied as a lotion or 
with vaseline; as an application in urticaria (Tftx to glycerin f5j), 
and in erythema ; to relieve the pain and itching of chilblain ; as a 
wash to cleanse the parts in psoriasis and phthiriasis. In epistaxis 
carbolic acid in olive-oil (Tftv-x to fsj) passed through the nostrils 
will often stop obstinate bleeding. 

To check the fetor of the breath arising from carious teeth, and 
as a mouth-wash in gingivitis it is of service. Carbolic acid is much 
employed in the form of aqueous solution or in oil as a dressing to 
foul ulcers, opened abscesses, sinuses, fistida, buboes, etc., to compound 
fractures, to burns and scalds . to suppurating surfaces with a view to 
checking this process and the prevention of pyemia, and for its use 
in coagulating albumen as an hemostatic agent in hemorrhage. 

In aural therapeutics carbolic solution is employed to cleanse 
the auditory canal before the introduction of powders as in otorrhoea 
and myringitis. A minute portion applied to the hollow of a cari- 
ous tooth will often alleviate toothache. It is one of the local rem- 
edies used in endometritis, and may be mixed in glycerin and 
applied upon cotton within the uterus. As a deodorizing-antisep- 
tic agent it has a wide range of usefulness ; to this end it may be 
injected into the vagina in female gonorrhoea, to keep clean the 
glans penis in balanitis and to purify the nostrils in ozcena. Under 
the belief that carbolic acid destroys the organic floating germs 
which produce inflammation and suppuration upon wounded sur- 
faces, washings and dressings with solutions of this acid (i part to 
40 parts of water) have been much employed, as first suggested by 
Sir J. Lister, of Edinburgh. It is also a most valuable disinfectant. 

Administration. — The dose internally is gr. j-ij or, if liquefied 
by heat, gtt. i-j, in sweetened water or glycerin. For topical pur- 
poses it may be dissolved in olive-oil or water, 1 to 10, 20 or 50. 



502 MATERIA MEDIC A AND THERAPEUTICS. 

For disinfectant purposes, the crude liquid acid (which contains 
from 70 to 90 per cent, of carbolic and cresylic acids jointly, with 
impurities derived from coal-tar) answers very well. Sodium and 
potassium carbolates have been also employed. Ointment of car- 
bolic acid (iinguentum acidi carbolici) contains 10 per cent, of car- 
bolic acid in ointment. 

Sodii sulpho-carbolas (Sodium sidpho-carbolate) (NaC 6 H 5 S0 4 . 
2H 2 0) is a colorless, transparent salt occurring in rhombic 
prisms, permanent in the air, soluble in about 5 parts of water, and 
also in glycerin and alcohol. It is obtained by adding sodium 
carbonate to a solution of barium sulpho-carbolate, previously ob- 
tained by adding barium carbonate to sulpho-carbolic- acid (made 
by dissolving one part of crystallized carbolic acid in an equal 
amount by weight of strong sulphuric acid — C 6 H 5 HO-fH 2 S0 4 =C 6 
H 5 HS0 4 -f-H 2 0), and stirring until effervescence ceases and then 
filtering. 

Potassium, magnesium and calcium sulpho-carbolates have 
also been employed ; they may be given as antiseptics in cholera 
and zymotic diseases generally. They are recommended as excel- 
lent topical applications to inflamed mucous membranes, and good 
results have attended their use in acute tonsillitis, aphtha of cluldren, 
acute nasal catarrh and gonorrhoea. Sodium sulpho-carbolate is a 
good remedy for flatulence ; dose, gr. x-xv. The lead sulpho-car- 
bolate might be used where the lead acetate is indicated and the 
corrective action of carbolic acid is called for, while its solubility 
in glycerin and alcohol adapt it to external application. 

CREASOTUM— CREASOTE. 

Preparation and Constituents. — Creasote is a complex sub- 
stance obtained from wood-tar by dry distillation, or from crude 
pyroligneous acid ; the best is made from beechwood-tar. It con- 
tains phenol (C 6 H 5 HO), cresol (C 6 H 4 (CH 3 )HO), creasol (C 8 H 10 O 2 ), 
and guaiacol, besides other substances obtained from wood-tar. 
When pure it is a colorless, oleaginous liquid, with a caustic, burn- 
ing taste and a penetrating, disagreeable, characteristic odor, like 
that of smoked meat. Its sp. gr. (U. S. P.) is 1.03 5- 1.08 5, but 
when pure is 1.080. After exposure to light for a long period it 
becomes wine-yellow ; if it turn red, it is not fit for medicinal use. 
It forms two solutions with water, one of I part to 80 parts of 
water, the other of 1 part of water to 10 parts of creasote; and it is 



ANTISEPTICS AND ANTIPYRETICS. 503 

soluble, in all proportions, in alcohol, ether, naphtha, and glacial 
acetic acid. 

Tests. — Crude phenol is often substituted for creasote; the 
latter may be distinguished by its insolubility in commercial glycer- 
in ; by not precipitating nitro-cellulose from collodion when mixed 
with it ; by giving a green color with ferric chloride and alcohol 
(phenol gives a brown color) and by yielding a green color passing 
to brown with ferric chloride and ammonium hydrate (phenol giv- 
ing a violet color) (Witthaus). 

Incompatibles. — Strong sulphuric and nitric acid decompose it ; 
and it reduces some of the metallic salts as silver nitrate. 

Aids. — Phenol and its derivatives. 

Effects and Uses. — Creasote possesses many properties in 
common with carbolic acid. A remarkable property of creasote is 
its power of preserving meat, whence its name (from xpiaz, flesh, 
and <T(ozu>, I save.) It is eliminated by the bronchial mucous mem- 
brane (which it stimulates as it passes out, and' hence is a good ex- 
pectorant), by the kidneys, etc. It is not much used because of 
the difficulty of procuring the pure drug. In large doses it is an 
acro-narcotic poison, resembling carbolic acid, but with more 
marked nervous symptoms. In cases of poisoning from creasote 
the same treatment is to be resorted to as in poisoning by carbolic 
acid. 

In small doses it is styptic and astringent, as it coagulates al- 
bumen, and, though not very nearly allied to the vegetable astrin- 
gent articles that contain tannic acid, it is, perhaps more generally 
administered for its astringent than for any other properties. It is 
an excellent remedy in hematemesis, and is also employed in hem- 
opytsis and other hemorrhages. It is very efficacious in allaying 
vomiting, eructations and gastric irritability, and has been exhibited 
for its astringent virtues with good effects in chronic diarrhoea and 
chronic bronchitis, and as a nervine in epilepsy, hysteria, neuralgia, 
etc. 

Externally it is applied in various degrees of dilution, to indo- 
lent, sloughing and foul ulcers. In the concentrated form it is a 
good styptic in capillary hemorrhages, and it is applied with effect 
to the hollows of carious teeth, for the removal of the pain of 
toothache. 

Administration. — Dose, internally, ITLj-iij, frequently repeated, 
in pill or diluted with mucilage. 



504 MATERIA MEDIC A AND THERAPEUTICS. 

For external use, from gtt. ij-vj, or more may be added to fSj 
of distilled water. 

Aqua Creasoti (Creasote -Water) (i part to distilled water 99 
parts). It may be used locally as a slightly stimulating lotion, or 
mixed with poultices to correct fetor. Internally it is a convenient 
form of administration. Dose f5j-jv. 

Nitro-benzine is an important agent in the aniline industries, 
being used in the manufacture of the latter for commercial pur- 
poses. It is not employed in medicine, but is interesting on account 
of the numerous cases of poisoning which have occured from its use 
in perfumery (in which it is known as the "Essence of Mirbane"), 
and to impart the flavor and smell of bitter almonds to articles of 
food or beverages. It has also been taken by mistake for a 
liqueur* The proper treatment of poisoning by this substance is 
the prompt evacuation of the contents of the stomach if it has been 
swallowed, artificial respiration, and blood-letting followed by 
transfusion. 

Aniline is used especially in the manufacture of brilliant dyes. 
Numerous cases of poisoning are on record from the ingestion of 
confectionery, etc., colored by this means. 

The various aniline- colors are used in medicine as reagents in 
staining bacilli for microscopical examination. It is also interest- 
ing as being the base of aniline acetate, from which antifebrin, one 
of the latest and most powerful antipyretics, is obtained. 

ACETANILIDE. 

Preparation and Chemistry. — Acetanilide or Antifebrin (C 6 
H 5 NH.COCH 3 , — not official) is a neutral chemical product, pre- 
pared by heating aniline with crystallizable acetic acid in a special 
receptacle, distilling the product and purifying by successive crys- 
tallizations, and consists of aniline acetate from which the elements 
of water have been separated by a dialytic action at an elevated 
temperature (Merck). 

It is a very stable compound, resisting the action of acids and 
alkalies at ordinary temperatures, and occurs in the form of a white 
crystalline powder, odorless, having a slightly sharp, but not dis- 



* Deutsche mUit.-Zeitung, II, 1873, 



ANTISEPTICS AND ANTIPYRETICS. 505 

agreeable taste, almost insoluble in cold water (i to 160 parts), but 
easily soluble in boiling water (i to 25 parts), alcohol (3^) and 
ether (6). 

Physiological Effects. — The most important effects of this 
drug are the rapid lowering of febrile 'temperature and the power 
which it possesses of moderating the activity of the nerve-centres. 

As an antipyretic it is four times more powerful than anti- 
pyrine, causing a reduction of temperature within an hour after 
its administration, the minimum being attained in from three to five 
hours, followed at first by a slow and then a more rapid rise until 
the temperature reaches the original height, or even a little be- 
yond it, in from three to twelve hours.* This action is more marked 
when the temperature is very high,f and when the medicine is so 
administered that the artificial reduction will take place coincidently 
with the natural subsidence: thus its effects are greater when given 
in the morning. More or less profuse perspiration occurs during 
the reduction of the body-heat, and the succeeding rise is some- 
times preceded by a rigor. 

From extensive and careful experiments with acetanilide, 
thallin and antipyrine, PasternatzkyJ concludes that from five to ten 
minutes after taking either of these substances, the internal temper- 
ature rises, and the heat given off by radiation is increased in direct 
proportion to the elevation of the cutaneous temperature, although 
the maximum elevation is attained earlier than the maximum loss 
of heat, and that the sweating coincides with the latter. During 
the second hour the internal temperature continues to fall, but with 
more intensity; the cutaneous temperature gradually subsides, and 
the loss of heat by radiation and the sweating diminish in direct 
proportion to the decline of the latter. Therefore, not only do they 
lower temperature, but they also balance the distribution of caloric 
in the system. They are antipyretic, by restraining nitrogenous 
metamorphosis, by limiting heat-production, and also by regulating 
the heat-distribution of the economy. These effects are only seen 
in a condition of pyrexia. As the temperature falls the pulse be- 
comes slower and stronger and the arterial tension is heightened. 
Acetanilide impairs temporarily the oxygen-carrying function of the 



* Centralbl.f. Klin. Med., No. 33, p. 1561. Cahn und Hepp. 
f Deutsche Med. Wochensch., No. 16, 1887. 
X Vratch, No. 2, p. 21 ; No. 4, p, 70, 1887. 



506 MATERIA MEDICA AND THERAPEUTICS. 

red corpuscles, by lessening the oxy-hemoglobin and forming with 
it methy-hemoglobin, as is shown by the cyanosis which is some- 
times observed, but this condition quickly passes away as the nor- 
mal condition of the blood is restored. 

Gastric or intestinal disturbance is of rare occurrence, while 
renal irritation never results, although the amount of urine is some- 
times considerably augumented; and lastly the elimination of urea 
is diminished.* 

In decided doses, acetanilide lowers the activity of the reflex 
centres, and reduces the conductivity of the motor and sensory 
nerves, probably to a great extent through its influence on the 
blood.f An inclination to sleep accompanies this analgesic action. 

Toxicology. — If given in lethal doses J (gr. v-x per kilo, of 
weight of animal), the effects are manifested primarily upon the 
constituents of the blood and then on the nervous system ; after- 
ward general prostration with stupor ensues and the temperature is 
rapidly and progressively lowered. Sensation is first diminished 
and then lost; the animal sinks into a comatose condition, followed 
by spasmodic convulsions, and dies in from 24 to 36 hours. The 
heart is at first accelerated then slowed, and the respiratory func- 
tions are markedly and progressively depressed. 

Medicinal Uses. — Acetanilide is chiefly used as an antipyretic 
and anodyne. For the former purpose it used to be more gene- 
rally employed than any other agent of this group, although some 
observers § regard antipyrine as safer, fearing the cyanosis tendency 
to collapse, and severe rigors which occasionally attend the action of 
acetanilide. 

In all cases of high temperature, notably in typhoid fever, phthisis, 
scarlatina, and rheumatism, it may be given in small doses, repeated 
as required, with excellent effect. 

In acute rheumatism it not only reduces the temperature, but 
also is said to act on the joints in as favorable a manner as do the 
salicylates. In croupous pneumonia, and in chronic catarrhal pneu- 
monia, it has been prescribed with advantage. 

It is used as an anodyne in the pains of the various nervous 

* Russ. Meditz., No. 43, 1886, p. 728. A. Berezovski. 

-j- Comptes Rendus de la Soc. de Biol., Juillet, iieme, 1887. M. Lepine. Rev. Med. de 
la Suisse Romande, Juin, 1887. M. Demieville. 

% Bull. Gen. de Therap., Fev. 2 8ieme, 1887. Dr. Weill. 

§ Co?nptes Rendus de V Acad, des Sciences, Avril i8ieme ( 1887. Germain See. 



ANTISEPTICS AND ANTIPYRETICS. 507 

diseases, especially those of locomotor ataxia; also in neuralgia, 
particularly of the fifth pair of cranial nerves; in headaches of var- 
ious kinds not depending on indigestion, and in dysmenorrhcea. 

In epilepsy it diminishes the violence and frequency of the petit 
vial, but does not seem to influence the grand mal. 

Administration. — The dose of acetanilide ranges from gr. jv- 
viij, though much larger quantities have been taken with safety. 
It is best administered in capsules or in powder, as it diffuses readily 
into the blood in spite of its insolubility. 

EXALGINE.— (METHYLACETANILIDE). 

Preparation and Chemistry. — Exalgine (not official) from ec, 
without, and a/^oc, pain, discovered by Hoffman in 1874, and quite 
recently introduced, is obtained by heating methylaniline with acetyl 
chloride and purifying the product by successive crystallization in 
pure alcohol and water. It occurs in long, white, fine crystals, 
tasteless and odorless, slightly soluble in water, but dissolving 
readily in alcohol pure or diluted. It is, theoretically, of complex 

structure as follows: for 2 of the H's of aniline C 6 H 5 N ^ there are 

substituted 2 different molecules, one, acetyl (C 2 H 3 0), the other 
methyl (CH 3 ), hence the formula CH 3 C 2 H 3 OC 6 H 5 N, and the name 
methylacetanilide. 

Incompatibles. — It reduces, dissolved in dilute alcohol, potas- 
sium permanganate; with the iodides, iodine is liberated, and liquor 
potassae, a precipitate, is formed. 

Aids. — Its analgesic and antipyretic effects are increased by 
the agents of this class, as antipyrine and salol ; also in the first 
named range by belladonna, opium and cocaine. Insoluble rem- 
edies like salol and antipyrine may be taken in the same capsule. 

Physiological Effects. — These have been carefully investi- 
gated by Gandineau,* who found that in man a dose of gr. jv-vj 
produces no phenomena, except perhaps a slight buzzing within 
the ears. When injected under the skin of mammals, clonic con- 
vulsions, accelerated breathing and salivation are produced accom- 
panied by lowering of temperature. Lethal quantities, about gr. vj 
per 2*4 lbs. of the animal's weight, destroy life by collapse, the 
blood being found dark colored through reduction of the oxyhemo- 

* Bull. Gen. de Therap., 1889, p. 207 ; also Lancet, London, vol. ii, 1891, p. 950. 



508 MATERIA MEDICA AND THERAPEUTICS. 

globin. It benumbs the parts of the tongue to which it may be 
applied. Exalgine affects profoundly the cerebro-spinal axis, full 
doses producing trembling, anxiety, loss of sensibility, and motor- 
power, the tactile sense persisting, until life terminates by respira- 
tory paralysis. But little alteration of arterial pressure and cardiac 
action has been noted. It is only by the exhibition of a quantity 
sufficient to bring about its full action that benefit is to be derived 
from its use. Caution, however, must be enjoined with this new 
remedy, as lethal effects have been produced with medicinal doses. 

Medicinal Uses. — This new medicament, by reason of its 
peculiar property of diminishing sensibility, should be adapted to the 
treatment of neuralgia, sciatica, lumbago, and to allay the fugacious 
pains of locomotor ataxia* It is not to be understood, however, as 
supplanting the old and well-tried remedies, but rather as a new- 
comer under trial. It has to a certain extent, been employed with 
success as an analgesic, in cases of neuralgia, migraine, and tor- 
ticollis in the dose of gr. j-yj per diem. Lowenthalf reports fair 
results in 35 cases of chorea treated with exalgine, the dose being 
gr. iij t. d. 

Administration. — The dose varies from gr. vj-x in 24 hours. 
As exalgine is but slightly soluble in water it may be administered 
either in elixir or capsule. 

ACIDUM BENZOICUM— BENZOIC ACID 

Preparation and Description. — Benzoic Acid (HC 7 H 5 2 ) is 
obtained from benzoin by sublimation, or by the action of alkalies ; 
it is also made in Germany from hippuric acid. As obtained by 
sublimation, it occurs in white, soft, feathery hexagonal crystals, 
of a silky lustre, and not pulverulent. It has more or less of the 
agreeable odor of the balsams, a warm, acrid and acidulous taste, 
is inflammable, sparingly soluble in cold water, rather soluble in 
boiling water, but perfectly soluble in alcohol, alkaline solutions 
and fixed oils. It is a constituent of the balsams. 

Incompatibles. — With the alkaline salts, as those of potas- 
sium, sodium, etc. 

Aids. — Borax and boric acid. 

Effects and Uses. — Benzoic acid is a local irritant, destroying 



* Bull, Gen. de T/ierap., Fevrier, 1890, p. 214. 
f Berliner Klinische Wochen., Feb. 1st, 1891. 



ANTISEPTICS AND ANTIPYRETICS. 509 

minute organisms, possessing decided antiseptic properties, and 
acting on the general system as a stimulant, with a particular direc- 
tion to the mucous surfaces. In large doses it increases the action 
of the circulatory and respiratory apparatus, and is said to be a more 
powerful antipyretic than salicylic acid. It stimulates the cutaneous 
and bronchial secretions, and increases the acidity of the urine. 
In its passage through the system It is partly decomposed, passing 
out with the urine in the form of hippuric and benzoic acids, during 
which it plays the part of a mild antiseptic as well as acidifying the 
urine, hence its value in the treatment of ammoniacal urine, pyelone- 
phritis, and in cystitis and irritable bladder, when accompanied by 
alkalinity and phosphatic deposits. It has been used in diphtheria, 
erysipelas, etc., with a view to its antiseptic effects, and as an ex- 
pectorant in chronic bronchial affections. Locally, it is employed 
as a dressing for wounds, ulcers, etc., and to prevent animal fats from 
becoming rancid. 

Administration. — Dose, gr. v-xx; if in pill soap should be the 
excipient. 

Sodii Benzbas {Sodium Benzoate) (NaC 7 H 5 2 H 2 0) is a white 
amorphous powder, freely soluble in water, which effloresces on 
exposure to the air, and has a faint odor of benzoin and a sweetish, 
astringent taste. It has been prescribed as a substitute for salicylic 
acid, being less powerful as an antipyretic, but is a safer remedy. 
It has been used extensively in phthisis, with a view to its antiseptic 
qualities ; also in diphtheria, scarlet fever and the eruptive fevers 
generally, whooping-cough, etc.; and in acute rheumatism as an anti- 
pyretic. From 5j-iij may be given in twenty-four hours. 

Ammonii Benzoas {Ammonium Benzoate) (NH 4 C 7 H 5 2 ) is made 
by adding water of ammonia to an aqueous solution of benzoic 
acid, and occurs in the form of minute white, shining, thin, four- 
sided laminar crystals, with a slight odor of benzoic acid and 
a bitterish, saline, somewhat balsamic taste and slightly acrid 
but persistent after-taste. It is soluble in water and alcohol, and, 
when heated, sublimates without residue. It is incompatible with 
the ferric salts. 

This salt, when taken internally, is probably decomposed by 
the gastric acids, and produces the constitutional effects of benzoic 
acid, for which it may be substituted; the ammonia renders it stim- 
ulant and antacid, and acceptable to irritable stomachs. It is an 



510 MATERIA MEDICA AND THERAPEUTICS. 

excellent remedy for incontinence of urine due to the irritation pro- 
duced by an alkaline condition of that fluid, and is used with advan- 
tage in irritable bladder whenever the urine is alkaline and loaded 
with phosphates. Dose, gr. v-xx. 

RESORCIN. 

Resorcin (not official), chemically meta-oxyphenol, derives its 
name from having been first obtained from certain resins by the ac- 
tion of alkalies, and from bearing some resemblance to orcin. 

Description. — It occurs as shining tabular crystals, having a 
slightly phenol-like odor and a sharp-sweetish taste, soluble in most 
liquids, especially in water. 

Physiological Effects. — Locally it is an antifermentative and 
antiputrefactive agent, destroying the organisms on which these pro- 
cesses depend. Internally, like other agents of this group, resorcin 
promptly reduces febrile temperature when administered in medici- 
nal doses, but it does not seem to affect the temperature of healthy 
individuals, as Dr. Justus Andeer, experimenting upon himself, took 
as much as 10 grammes without observing a reduction of body- 
heat. 

The antipyretic action is more marked in typhoid fever, 
pneumonia and erysipelas than in other febrile states, although it is 
present to some extent in malaria, and indeed it appears to possess 
some antiperiodic power, as might be inferred a priori from the close 
chemical relationship which it bears to quinine, to which, however, 
it is very far inferior in this respect. It is well borne by the stom- 
ach. The decrease in the temperature of fever is usually preceded 
by transient vertigo, tinnitus aurium, flushing of the face, headache 
and oppression in the chest. As the temperature declines there is 
nearly always a profuse perspiration, and the pulse and respiration, 
which were at first accelerated, are markedly slowed. This occurs 
in about one hour after the ingestion of the drug and continues 
for from two to four hours, and is then followed by a more or less 
well-marked chill and a gradual rise in temperature. Elimination 
takes place rapidly, chiefly through the urine. 

Toxicology. — When a large dose is given to an animal, trem- 
bling supervenes, soon followed by general epileptiform convulsions, 
each occupying a few minutes only, which regularly increase in se- 
verity, reach their maximum and as regularly decline. The gen- 
eral sensibility is not affected. The convulsions appear to be of 



ANTISEPTICS AND ANTIPYRETICS. 511 

spinal origin. The pulse is weak, rapid, and irregular, the breathing 
accelerated, convulsive, then shallow and weak, and finally death 
takes place from failure of respiration, preceded by a rise in tem- 
perature from excessive muscular action. 

Medicinal Uses. — As an antipyretic resorcin has been used in 
typhoid fever, pneumonia, erysipelas, acute rheumatism, and septice- 
mia. It has also been given in malaria, especially in the intermittent 
form, and is said to diminish recent splenic tumefaction, and to an- 
tagonize the malarial cachexia (Righi*). As a sedative and antifer- 
mentative it is used in acute gastro-intestinal catarrh, gastrodynia 
and dyspepsia due to the fermentation of the ingesta, for which pur- 
pose it may be advantageously combined with sodium bicarbonate. 

Locally it has been applied as an antiseptic to unhealthy ulcers 
and wounds, and to destroy fetor and promote healthy granulations. 
Unna recommends a 5 or 10 per cent, ointment in phthiriasis capitis, 
squamous eczema of the head and in seborrhceal eczema. In psoria- 
sis an ointment of the strength of 10 to 20 per cent, may be used 
with advantage. The powder or a strong ointment may be applied 
in parasitic sycosis with marked benefitf. 

According to Dr. Jacksonf, it is very useful in epitheliomatous 
lesions where surgical interference is contraindicated, as it exerts a 
powerful absorptive effect on new cell-infiltrations. Pure resorcin 
has also been powdered on condylomata of the penis, vulva or anus 
with brilliant results§. It is also used in solution of various strengths 
in various diseases of the mucous membranes, as in acute or chronic 
conjunctivitis ; as a disinfectant, antiseptic, and in strong solutions, 
as a caustic in laryngeal diseases. In tubercidar ulceration of the 
larynx, the pain soon subsides and the cough diminishes after these 
applications. 

In gleets. 2 per cent, solution may be injected into the urethra 
with excellent effect (Dr. Justus Andeer||, Righi, op. cit.). 

Administration. — The ordinary dose is gr. v-xv, either in 
capsules or in solution in alcohol, glycerin or water, disguised with 
syrup of orange-peel. These doses may be repeated every four 
hours. Much larger amounts have been taken without producing 



* El Siglo Medico, Mar. 9, 1884. 

f Centralbl. f. die ges. Therap., Mar. 1886, Ihle. 

XJourn. Cutan. and Genii.- Urin. Diseases, Vol. V, Nos. 6 and 7. 

g Russ. Meditz., No. 38, 1886, p. 639, Gatchovsky. 

|| Centralbl./. die gesammte Therap., Apr. 1884. 



512 MATERIA MEDICA AND THERAPEUTICS. 

injurious or alarming symptoms. For topical application it maybe 
made up with vaseline, 5 to 20 per cent. ; or dissolved in water. 

Hydroquinone or Hydrochinone (para-oxyphenol) and Pyro- 
catechin (ortho-oxyphenol), neither of which are official, are isomers 
ofresorcin, as has already been pointed out. Their effects are iden- 
tical with those of the latter, than which they are about four times 
as powerful. They are little used, being superseded by acetanilide 
and other antipyretics of more recent date, although, by some, 
hydroquinone* is thought to be among the most powerful and least 
harmful remedies of this group. 

ACIDUM SALICYLICUM— SALICYLIC ACID. 

This acid although known for nearly half a century as a deriva- 
tive of salicin (see p. 161) has been employed only since 1875 as an 
article of the Materia Medica. 

Preparation. — It has been prepared from the flowers of Spircea 
ulmaria or Meadow-Sweet, and from the oil of gaultheria (where it 
exists as methyl salicylate), and by the oxidation of salicin. It 
is now made by combining pure carbolic acid with caustic soda, 
and treating this compound with dry carbonic acid under the in- 
fluence of a gradually-increasing heat, when one-half of the carbolic 
acid distils over, while the other half, into the molecule of which 
carbonic acid enters, remains behind as sodium salicylate ; from a 
hot aqueous solution of this, saturated with hydrochloric acid, sali- 
cylic acid (C 6 H 4 {cooh}) is obtained in the form of minute, broken, 
acicular crystals (having usually the appearance of a pale-pinkish 
granular powder), which are bleached with great difficulty. 

Chemistry and Test. — It is odorless and nearly tasteless, hav- 
ing, however, a sweet and astringent after-taste, with slight acridity 
in the fauces. It is practically insoluble in cold water, but quite 
soluble in boiling water, a hot aqueous solution retaining when cold, 
in proportion to its coldness, 1 part in from 250 to 500 parts of the so- 
lution. The addition of two parts of sodium sulphite, or I part of am- 
monium phosphate, or three parts of sodium phosphate, renders it 
much more soluble in water. It is freely soluble in alcohol, ether and 
glycerin. Test. — Dissolved in water, a fine violet color is produced 
on the addition of ferric chloride. 

Incompatibles. — The ferric salts, alkalies, and mineral acids. 

* Berliner Klin. Wochensck., No. 29, 1884, Dr. P. Seifert. 



ANTISEPTICS AND ANTIPYRETICS. 513 

Aids. — Antiseptics, antipyretics, and cardiac depressants. 

Physiological Effects. — In its effects salicylic acid is allied to 
carbolic acid, possessing probably greater powers as an antiseptic in 
arresting the putrefactive and fermentative processes, while it is devoid 
of smell or notable taste, is not volatile, and is also, in quantities 
necessary for effective action, free from irritant or poisonous influ- 
ence. When given internally in full medicinal doses buzzing and 
roaring in the ears, with fulness in the head are experienced, which 
are much increased after the administration of larger doses, amount- 
ing even to deafness and partial blindness. If an excessive dose be 
taken all the symptoms are intensified, and great restlessness fol- 
lowed by delirium, involuntary evacuations, stupor, and in the lower 
animals convulsions, are observed. The action of salicylic acid 
upon the ear (as well as the similar action of quinine) has been in- 
vestigated with varying results. Kirchner concludes that these 
remedies produce intense congestion of the tympanum and labyrinth 
(due to vaso-motor disturbance), which may leacl to changes in the 
nerve-filaments ; while Weber- Liel and Guder* found anemia of 
these parts as the result of the ingestion of the drug. 

The heart-beat is first increased in frequency, but afterward 
slowed ; excessive doses cause the pulse to become slow and labored. 
The blood-pressure is at first elevated (from the action of the acid 
on the heart and on the vaso-motor centres), then lowered. Blood : 
Prudden,f from experiments upon frogs, verified on rabbits and on 
the human blood, concludes that salicylic acid restrains the migra- 
tion, and in strong solutions is inimical to the life, in weak solutions 
to the activity, of the white blood corpuscles. Respiration is at 
first quicker and deeper than normal from the action of the drug on 
the vagi and to some extent on the respiratory centre ; later it be- 
comes slow and labored, and death results from asphyxia. Temper- 
ature : non-toxic doses have little or no effect upon the normal 
temperature; in fever, however, salicylic acid causes a marked re- 
duction in the body-heat which lasts several hours. Secretion : 
full doses cause free diaphoresis which is sometimes exhausting. 
The urinary flow is augmented and the proportion of urea, uric and 
phosphoric acids in the urine, increased. It somewhat favors the 
secretion of milk, and the amount of sugar in that secretion seems 



* Med. Record, Oct. 28th, 1882. 

f Am. Jour. Med. Sci., LXXXII, 1882. 

33 



514 MATERIA MEDIC A AND THERAPEUTICS. 

to be heightened*. Gastrointestinal tract : large amounts cause 
nausea and often vomiting. Absorption and elimination : it is 
probably absorbed as a sodium salicylate, and is discharged by the 
urine mostly unchanged, though partly as salicyluric acid andsalicin. 
Elimination takes place slowly, though it appears in the urine 15 
minutes after being taken. After the ingestion of large quantities 
the urine will be colored green from an increase of the indican. 
Whether employed internally or externally a portion passes into 
the urine unchanged and gives with ferric chloride a blue or violet 
reaction. The acid retains its antiseptic properties only so long as 
it remains in the free state. 

Medicinal Uses. — For its antipyretic effects salicylic acid has 
been used in fevers with varying success. In acute rheumatism, es- 
pecially in robust patients, it is preeminently of value, reducing the 
temperature, relieving the joint-affection and ameliorating the pain; 
but whether it shortens the duration and decreases the frequency of 
cardiac complications and relapses is still disputed. In rheumatic 
hyperpyrexia it is of value, but it should not be relied on to the ex- 
clusion of other means of reducing temperature. In gonorrhceal 
rheumatism and gout, where no kidney complication exists, it is also 
of service, and it has been used in typhoid and the eruptive fevers, 
pyemia, puerperal fever , dengue, muscular rheumatism, diphtheria, etc. ; 
although not as effective in these diseases as in rheumatism, and, 
indeed, it has been condemned by some as being of no avail. It is 
serviceable in acute tonsillitis in doses of gr. x every two to four 
hours.f As an antizymotic to prevent fermentation of the ingesta 
its use is advised in gastric catarrh, gastric dilatation, sarcina and 
allied complaints. As an anthelmintic salicylic acid has been pre- 
scribed with success against tape-worm, and is also internally and 
locally used against ascarides. Externally it has been applied in 
the moist stages of eczema and eczema rubrum with good results, 
and in the form of ointment to tinea versicolor. 

As a detergent and desiccant it may be sprinkled dry on 
wounds or ulcers in the form of powder, or mixed in various pro- 
portions with some inert powder, as starch ; or a solution, 1 part to 
300 parts of water, may be used as a substitute for the antiseptic 
carbolic dressing; the stronger solution with sodium phosphate, I 

* Deutsches Arch. f. Klin. Med., Jan., 1882; Dr. Max Stumpf; also Bull. Gen. de 
TheraJ>.,Fkvrier, 1889, p. 119. 

f Brit. Med. Jour., Oct. 14th, 1882, Dr. Edward Mackey. 



ANTISEPTICS AND ANTIPYRETICS. 515 

part to 50 parts of water, is used to wash or spray foul surfaces, or 
as an application in diphtheria \ a solution of gr. j to fSj of water is a 
good injection in go?wrrhcea and collyrium in conjunctivitis. 

Administration. — Dose, gr. x-5j. The following solution 
makes an excellent application to inflamed or painful corns. Ify Acidi 
salicylici, gr. x; collodii flexilis, f5j- M. 

Sodii Salicylas {Sodium Salicylate) (2NaC 7 H 5 3 .H 2 0) is a 
white crystalline powder, without smell, having a sweetish, alkaline 
taste. 

Internally its effects and uses are identical with those of salicylic 
acid, to which it is preferred, because it is more soluble in water, 
and causes less gastric irritation. 

Dr. Gasparini* employs it in pleurisy when diaphoretic treat- 
ment is indicated. 

Locally it is recommended in solution (sodium salicylate, 3ij ; 
laudanum, f5ij ; water, fSviij) to relieve the suffering caused by 
gouty hands and feet, and rheumatic joints^. 

Dr. Baudon anoints the surface three times a day, in variola, 
with sodium salicylate, 3j ; in cold cream, gj, and claims that it 
lessens the suppuration and removes the odor. 

Lithii Salicylas {Lithium Salicylate) is also official, and is used 
internally to fulfill the indications of salicylic acid. The salts are 
given in doses corresponding to those of the acid. 

SALOL. 

Salol (not official) is an ether-combination of salicylic acid, 60 
per cent., and carbolic acid, 40 per cent. It is not a salicylate of 
phenol as has been erroneously stated in some quarters, but a sal- 
icylic-phenol-ether, and occurs as a white, tasteless powder, having 
a faint odor resembling carbolic acid, slightly unctuous to the touch, 
insoluble in water, but easily soluble in alcohol, in ether and in the 
fixed and volatile oils. 

Physiological Effects. — It is an antiseptic, not a germicide, 
for, like iodoform, it will prevent the formation of bacteria, but does 
not destroy them when actually present (Neneki). Locally, as it is 
insoluble, it does not irritate the skin nor the surface of wounds when 

* Gaz. Med. Ital., Lombard, March, 1885. 

f Brit. Med. Jour., Oct. 14, 1882, Dr. E. Mackey. 



516 MATERIA MEDICA AND THERAPEUTICS. 

applied to them, and hence may well replace iodoform in local an- 
tisepsis. When administered internally, it reduces febrile tempera- 
ture, but has no influence over that of health. This antipyretic 
action is very marked, occurs suddenly fifteen minutes after saloi 
has been taken, and is to a certain extent independent of the amount 
administered ;* that is to say repeated doses will not lower a tem- 
perature already reduced by a single dose, although they will main- 
tain the reduction. Simultaneously with the decline of the fever, 
sweating occurs, as in the case of the other agents of this group, 
but it is not marked, nor do the chilly sensations which sometimes 
precede the rise of temperature ever amount to a distinct chill"}". 
The circulation is but little influenced, even by large doses of salol 
(Lombard loc. cit.) but the respirations increase rapidly, so much so, 
that at the expiration of ten minutes after taking the medicine, they 
have doubled in frequency, at the same time becoming very shal- 
low, and although they are soon slowed yet some time elapses be- 
fore they return to their normal depth. Salol also possesses 
analgesic properties in common with other antipyretics of the aro- 
matic series of carbon-compounds, but this subject has as yet not 
been sufficiently investigated, to warrant a positive statement regard- 
ing its cause. 

When salol is taken with food, it is said to pass unchanged and 
undissolved through the stomach into the duodenum, where under 
the action of the pancreatic juice, it .is converted into carbolic and 
salicylic acids ; hence it will act as an intestinal antiseptic without 
affecting the stomach. It is said, too, to render the bile more fluid. 
No toxic symptoms have been observed, and it is believed to be innoc- 
uous. It is eliminated principally through the kidneys, under the form 
of salicyluric acid and phenol-ether-sulphuric acid, the latter impart- 
ing the dark color to the urine, although during a course of salol, the 
urine assumes a dark hue similar to that seen when large amounts 
of carbolic acid are taken. 

Medicinal Uses. — Salol has been much used in acute rheuma- 
tism to lower the temperature and relieve the pain, and although it 
does this most promptly, its effects are much more evanescent than 
are those of sodium salicylate. It neither prevents relapses nor 
lessens the tendency to cardiac complications. It has also been pre- 



* Bull. Gen. de Therap., I5ieme, 1887, Dr. Lombard. 

f Deutch. Med. Wochenschr., No. 19, 1887, Dr. Herrlich. 



ANTISEPTICS AND ANTIPYRETICS. 517 

scribed in small doses to lower the temperature in phthisis (gr. j-iij 
every few hours), and it is recommended in typhoid fever and pneu- 
monia for a similar purpose. 

It has been found very serviceable in intestinal catarrh, espe- 
cially when the upper part of the tube is affected ; thus in catarrh 
of the duodenum it is of special value, as it is there that it is re-con- 
verted into its constituent parts. As it tends to liquefy the bile, it 
is also recommended in catarrhal jaundice , in cases of occlusion of 
the bile-ducts from inspissated bile. Salol in obstinate diarrhoea* 
when the stools are unusually fetid, by reason of its antiputrefactive 
properties, often renders valuable aid, particularly when combined 
with suitable dietetic treatment, and under its influence they lose 
their fetor and regain their normal consistence. 

Prof, von Nencki and others recommend it in the treatment of 
acute cystitis, since it has been found to entirely prevent the decom- 
position of urine when mixed with it ; and since its component parts 
are eliminated unchanged by the kidneys, a similar effect probably 
follows its internal administration. 

Like many of the antipyretics, it possesses the property, when 
administered internally (gr. iij-x, t. d.), of relieving the pains of 
locomotor ataxia, neuritis, nervous headache and neuralgia to a re- 
markable degree, and it also exerts a similar, though less marked 
influence, over lumbago, myalgia and other muscular pains. 

Locally it has been used as an antiseptic in the dressing of 
wounds y ulcers and other surgical affections ; and, as it does not ap- 
pear to be toxic, and is to a great extent free from disagreeable 
odor, it would seem to be an excellent substitute for iodoform. 

Administration. — Salol may be given in capsules, pills, powder 
or in solution in alcohol or in oil. The dose ranges from gr. v-5 j- 
As an antipyretic the average dose is gr. xv-xxx, and as much as 
5ij-iij have been administered in twenty-four hours without dele- 
terious effects. It may be applied to burns, salol I part, olive-oil 
and lime-water each 60 parts : as an antiseptic powder equal parts 
of salol and starch well pulverized. 

NAPHTHALINE. 

Naphthaline (not official), when pure, occurs as thin, white, 
shining, rhombic crystals, having a strong, pungent odor and a 

* Bull. Gen. de Therap., t. ii., 1891, fegasse. 



518 MATERIA MEDICA AND THERAPEUTICS. 

burning taste, insoluble in water, diluted acids or alkalies, but dis- 
solving in alcohol, ether and oils.* 

It was introduced into medicine as an expectorant, and stimu- 
lating application,! but was first used as an antiseptic by Dr. E. 
Fischer,^ in 1881, who recommended it as cheap, innocuous, and as 
efficacious as carbolic acid. 

Physiological Effects. — Naphthaline is a disinfectant, deodo- 
rant, antifermentative and antiseptic agent, whether applied locally 
or administered internally. It has no antipyretic action. It does 
not irritate the stomach — in fact, it is believed to pass unchanged 
through that organ into the intestines, and there to act as an anti- 
septic, rendering the stools inodorous, or imparting to them its own 
odor to a slight degree. Although very insoluble, it is to some ex- 
tent absorbed, and eliminated by the lungs and kidneys, imparting 
a dark color to the urine (Binz), and in large doses irritating the 
kidneys, and even in some cases causing violent cystitis, with stran- 
gury^ In medicinal doses, it retards or prevents the decomposition 
of the urine, and hence is of value in cystitis. It is not toxic, proba- 
bly because of its insolubility. # 

Medicinal Uses. — -It is chiefly used internally^ as an antiseptic 
in the treatment of gastro-intestinal and renal and cystic disorders. 

In dyspepsia due to fermentation of food; in acute gastro-in- 
testinal catarrh (combined with opium) ; in chronic gastro-intestinal 
catarrh, to prevent fermentation and the consequent nausea, heart- 
burn and eructations, it is highly recommended. 

In acute diarrhoea and in dysentery it has also proved of use, 
but would appear to act more beneficially when combined with an 
evacuant plan of treatment than when given alone. 

It is also recommended in typhoid fever as an intestinal antiseptic. 
In pyelonephritis^ cystitis acute or chronic, chronic prostatitis with 
retention and decomposition of urine, and in cases of old strictures 
with multiple fistulse and ammoniacal urine, in doses of gr. xx, it is 
said rapidly to render the urine sweet, either limpid, neutral or acid 
in reaction, while it causes the pus to diminish or disappear alto- 
gether from that fluid. 



* Wienner Med. Blatter, No. 28, 1885, Binz. 
f Journ. de Pharm. et de Chim., 1842, Dupasquier. 
% Berlin, klin. Wochensch., XIX, 1882, p. 113-116. 
\ Ibid., No. 42, 1884, Rossbach. 
|| Cf. Binz. op. cit. 



ANTISEPTICS AND ANTIPYRETICS. 519 

It has also been successfully used to cause the expulsion of 
parasites from the alimentary canal, and may be administered for 
this purpose to children in cases of round or thread-worms in doses 
of gr. j-iij, t. d., or to adults with tcenia, in gr. xx-lxxx daily in 
divided doses (Koriander). 

It is also recommended as an expectorant. 

Locally naphthaline has been much lauded as a substitute for 
iodoform in the antiseptic treatment of wounds, abscesses and ulcers, 
either venereal or common ; and it has been used as a surgical dress- 
ing after surgical operations, and even after amputations, but does 
not appear to possess any special advantage over the stronger anti- 
septics (as corrosive sublimate) when carefully used. 

Administration. — Dose, gr. ss-viij to an adult. As much as 
gr. lxxx have been given without unpleasant results in twenty-four 
hours, but as cases of cystitis and strangury are sometimes produced, 
it is best to be cautious in administering naphthaline to a person 
unaccustomed to the drug. 

It is best administered in compressed pills or in capsules. 

Locally, it may be used either in the form of powder, ethereal 
solutions (5ss-j in ether f§ss) or ointment with vaseline. 

The peculiar and disagreeable odor of naphthaline may be al- 
tered and even rendered pleasant by trituration with a small quan- 
tity of the oil of bergamot.* 

NAPHTHOL. 

This substance (C 10 H 7 O, not official) is beta or z^-naphthol, and 
is derived from naphthaline. It occurs in the form of white cryst- 
als of carbolic odor, almost insoluble in water, but miscible in 
alcohol, ether, chloroform, and most of the oils. 

Incompatibles. — With subacetate of lead it forms a white 
creamy precipitate. Though practically insoluble in water, its al- 
coholic solution may safely be diluted 50 per cent, with water. 

Aids. — Topically by creasote and carbolic acid. 

Contraindications. — As it is eliminated by the kidneys, mak- 
ing the urine turbid and sometimes albuminous, it should not be ad- 
ministered when the renal apparatus does not perform its functions 
normally. 

Physiological Effects. — Locally, it is quickly absorbed ; 
when applied to the delicate tissues in aqueous solution (gr. ij to {§) 

* Am. Druggist, Jan., 1885, p. 17. 



520 MATERIA MEDICA AND THERAPEUTICS. 

it sets up a temporary sense of irritation and burning, but if dis- 
solved in a fatty substance (10 or 20 to 100) and rubbed on the 
healthy skin no irritation is provoked. When applied too freely it 
may become absorbed to the extent of inducing toxic effects, as 
vomiting, convulsions and hematuria. Beta-naphthol in weak solu- 
tion prevents completely the development of various kinds of mi- 
crobes, as those of yeast, the micrococci of pneumonia and of sup- 
puration ; and it retards the growth of the bacilli of typhoid fever and 
tuberculosis. It prevents the decomposition of the urine, and organic 
substances in full putrefaction cease to putrefy when brought in con- 
tact with it. Within the stomach about Svj ^ to a man weighing 
145 lbs. induce decided phenomena of intoxication, while toxic 
symptoms begin to come on when the quantity reaches giij, whe- 
ther introduced by rectal injection or the stomach. Compared with a 
naphthol it is more than x / 2 less toxic, but possesses *^ weaker germ- 
icidal powers. Naphthol readily destroys canine life. 

Medicinal Uses. — Naphthol, by reason of its germicidal vir- 
tues, is adapted to the treatment of cutaneous parasitic diseases. In 
the management oifavus and prurigo, either as a soap (2^ per cent.), 
or pomade (5 per cent.), applied alternately with sulphur-soap and 
friction at night, Kaposi praises this medicament highly ; while 
against scabies one day's treatment with frictions, the same observer 
found sufficient to effect a cure in a large number of cases. It is 
also applicable to the treatment of tinea versicolor and circinata. 
In psoriasis it is less efficacious than chrysarobin. Naphthol has 
been employed, too, to assist the cicatrization of chancroids and 
ulcers. 

Administration. — But little experience has been recorded 
with this remedy for internal use; it has, however, been given 
gr. 25 to 40 in the 24 hours in capsule, as an antiseptic agent in 
typhoid fever. For local use a pomade, 10 parts of naphthol to 
vaseline 100 ; and an alcoholic solution, 20 to 40 of the remedy to 
100 of fluid, are employed. Caution is enjoined with this remedy.* 

Pyridine (not official) is a clear, colorless, volatile liquid, with 
a strong, somewhat aromatic odor, and a burning taste; having a 
sp. gr. 0.98; boiling at 240. 8° F. and being readily miscible with 
water, alcohol, ether, benzine and the fixed oils, the resulting solu- 

* On Naphthol, see Egasse's article Bull. Gen. de Therap., 1891, t. 120, p. 399. 



ANTISEPTICS AND ANTIPYRETICS. 521 

tions being clear and, in case of the watery solution, of an exceed- 
ingly alkaline reaction. 

Physiological Effects. — When the vapor is inhaled by the 
lower animals the inherent irritability of the respiratory centre is 
greatly diminished, and the act of breathing becomes less frequent* 
When inhaled by man, less air is respired in a given period; indeed 
the feeling of need of air is diminished, while the respiratory curve 
in a healthy individual shows expiratory dyspnoea. The respira- 
tion becomes less frequent, irregular, somewhat periodic, and some- 
times long intervals of apncea are observed. After the inhalation, 
the breathing remains for some time less frequent and less full, with 
occasional deep inspirations. There is always abundant salivation, 
coryza, and increase of bronchial mucus, and sleep often supervenes. 
As the same effects (excepting the decreased need of air, sleep and 
increase of bronchial secretion) are observed when the nostrils are 
irritated by a faradaic current, Dr. Silva f believes that pyridine 
acts on the respiratory centre chiefly through the trigemini, but to 
some extent also by the vagi. According to De Renzi \ it is well 
borne by the stomach in doses of gtt. vj-xxv in water, and notably 
increases the force, while diminishing the frequency of the cardiac 
systole. The arterial pressure is raised. It has very slight anti- 
pyretic properties. § 

Medicinal UsES.^-It was first recommended as an inhalation, 
by Prof. See, in asthma. For this purpose f5j may be poured on 
a plate placed in a small room or closet, in which the patient re- 
mains for twenty or thirty minutes at a time, thrice daily. This 
treatment lessens the dyspnoea rapidly in all forms of asthma, and 
is free from dangerous consequences,|| as pyridine is rapidly ab- 
sorbed and as rapidly eliminated by the urine. 

In angina pectoris it is said to act very favorably and rapidly. \ 
According to De Renzi its action much resembles that of digitalis, 
for which it may often be substituted with advantage, as its 



*Bull. Gen. de Therapy Juin 3oieme ) Drs. Germain See, et Bochefontaine. 

f Gazz. delle Cliniche, June, 1886. 

% Riv. Clin, e Terap., No. 3, T887. 

I Vratch, No. 21, 1882. Dr. K. K. Sakovski. 

|| N. Y. Med. J., Mar. 13, 1886. Dr. Jos. Neff. Der Fortschritt, No. 1, Jan. 5, 1887. 
Dr. Wyss. 

^[ A monograph, " De la Pyridine et de la Collidine comme medicaments respiratoires.'' 
Par le'Docteur Dandien, Paris, 1886 ; Dr. Wyss, op. cit. ; De Renzi, op. cit. 



522 MATERIA MEDICA AND THERAPEUTICS. 

effects are more rapidly produced, and, being rapidly eliminated, its 
action is not cumulative. 

Chinoline (not official) is now manufactured synthetically in a 
pure state from aniline or nitro-benzol by the action of glycerin in 
the presence of a dehydrating agent by the process of Skraup, but 
was first obtained from coal tar by Runge and afterwards by 
Gerhardt and by Vyshnegradski from the cinchona alkaloids by 
decomposition. When pure it is an oily, colorless liquid with an 
aromatic odor, which combines readily with acids, forming salts of 
which the tartrate only is not deliquescent. 

Physiological Effects. — -Chinoline is antiseptic and antipy* 
retic, differing but little in its effects from other agents of this 
group. Simultaneously with the lowering of the temperature dia- 
phoresis occurs, which is sometimes profuse. This is preceded by 
a period of excitement, flushing of the face, accelerated cardiac ac- 
tion and elevated arterial tension, and is followed by a diminution 
in the frequency of the heart-beat and respiration. According to 
Dr. N. Sudeikin* besides lowering the " temperature, it acts chiefly 
on the nerve-centres, especially those of the spinal cord and me- 
dulla oblongata, paralyzing their reflex activity. It depresses, and 
in large doses paralyzes the respiratory centres and the excito- 
motor cardiac nerves. The hope, at one time entertained, that in 
this remedy the long-sought substitute for quinine had at length 
been found, has been doomed to disappointment, though it is un- 
doubtedly a powerful antipyretic and to some extent an antiseptic. 

Medicinal Uses. — It has been used to lower the temperature 
in typhoid fever, acute rheumatism, and erysipelas. In pneumonia 
and malarial fevers it is decidedly inferior to other agents, and in 
phthisis it is not to be recommended. 

The more recent antipyretics are preferable, as from the com- 
parative smallness of dose they can be more readily handled and are 
not so apt to cause profound depression. 

Administration.-— The pure drug may be given hypodermi- 
cally in solution in olive-oil (i to 2) which is said not to cause 
irritation or inflammation, or the tartrate may be exhibited inter- 
nally in solution — dose gr. vij-xv. 

Kairine (not official) is a pale buff-colored powder, slightly 
soluble in water, having a bitter, disagreeable taste. 

* Vratch, Nos. 21, 29 and 30, 1882. 



ANTISEPTICS AND ANTIPYRETICS. 523 

Physiological Effects. — It was first investigated physiologi- 
cally, by Prof. Filehne, of Erlangen,* who recommended it highly 
as an antipyretic, for which purpose it was largely used for several 
years in the treatment of numerous diseases accompanied by high 
febrile temperature. Of late, however, it has been superseded as 
an antipyretic by antipyrine, acetanilide and other more recent, and 
probably, less dangerous members of this group of medicines. In 
brief, its action is as follows : f 

It is a blood-poison acting on the red-corpuscles, destroying 
the hemoglobin with the formation of methemoglobin,J and partly 
destroying the plasma. The febrile temperature is rapidly reduced 
to the normal, the fall being accompanied by profuse sweating; but 
after a short time the temperature again rises, preceding which 
rigors sometimes occur. The reflex centres of the cord are 
depressed and finally paralyzed if a large amount has been taken. 
The cardiac action is at first slowed (from depression of the excito- 
motor cardiac ganglia, and probably also from irritation of the in- 
hibitory cardiac ganglia), but is afterwards accelerated (from excita- 
tion of the central ends of the accelerator fibres of the vagi), and 
finally in fatal cases, paralysis of the motor-cardiac ganglia, and 
arrest of cardiac contractions ensues, the cavities of the heart being 
greatly distended. Respiration is slowed, and, when lethal amounts 
are taken, ceases from paralysis of that centre before the heart 
stops beating. Paresis, and finally complete paralysis of central 
origin results. The peripheral endings of the sensory nerves are at 
first excited, then paralyzed. When kairine is administered hypo- 
dermically local anaesthesia is always produced around the seat of 
the injection. 

Kairine is rapidly excreted and the lesions of the tissues and 
of the blood are not lasting, the animal recovering, even if symp- 
toms of dangerous collapse are present, when the medicine is re- 
moved from the system either by the urine or by venesection. It 
is eliminated chiefly by the urine, which is of a dark green color 
during its passage from the system. Cyanosis is often observed. 

The conclusion arrived at by Beyer,§ which the editor en- 



* Berlin. Klin. Wochensch., No. 45, 1882, und No. 6, 1883. 

f St. Petersburg Inaug. Dissert, 1885. Dr. M. K. Popoff; also Meditz. Oberz., Fasc. 

4, 1884, p. 406. Dr. L. M. Popoff. 
% Meditz. Oberz., Fasc. 9, 1884, p. 928. L. Morokhovez. 
\ Am. J. Med. Set., Apr., 1886, p. 382. H. G. Beyer, M. D., M. R. C S., U. S. Navy. 



524 MATERIA MEDIC A AND THERAPEUTICS. 

dorses, is that " the distinctive influence it exerts on the red blood- 
corpuscles " " and the weakening effect upon the heart, render its 
employment objectionable and dangerous." 

Administration. — Dose, gr. iij-xxx. The average quantity- 
required in fevers is gr. viij-xv, repeated hourly until the tempera- 
ture falls, when the dose is to be decreased. It may be given in 
capsules or wafers. 

Thalline (not official) is a synthetically prepared alkaloid 
belonging to this series, being chemically tetrahydroparamethyl- 
oxychinoline. The sulphate is the salt most generally in use, 
although the tartrate and hydrochlorate have also been -employed. 
Thalline sulphate is a light buff-colored powder, with a sharp, 
strongly bitter taste, and a slight phenol-like odor. The salts are 
all readily soluble in water. 

Physiological Effects. — Locally, thalline is an antiseptic and 
antifermcntative agent. Internally, it lowers the temperature of 
fever, but exerts little or no effect on that of health. The cutaneous 
vessels dilate, and while the internal temperature is lowered, that of 
the surface is elevated until they nearly correspond, and at the 
same time there is an increased radiation of heat from the surface,* 
with diaphoresis, which, however, is not as great as that pro- 
duced by kairine. As an antipyretic it acts rapidly, but the effect 
passes away in 4 or 5 hours, a more or less distinct rigor occurring, 
usually not severe, followed by a return of the fever. The pulse and 
respiration are both diminished in frequency, and the arterial ten- 
sion is at first elevated, afterward depressed. f According to Beyer 
(op. cit) when injected into the blood of frogs and turtles, small doses 
temporarily increase the heart-rate, but slightly diminish the work 
done by it ; in larger doses there is a decrease both of the cardiac 
rate and work, especially the latter ; very large doses cause diastolic 
arrest, five times as much being required as when kairine is 
used. The respiratory capacity of the blood after the administration 
of thalline, was measured by Maragliano and found to be reduced. 

Ehrlich % found that when given in excessive doses (to 
animals) for some time it collects in large quantities in the 
adipose tissues, being absorbed with great avidity by the oil- 

* Vratch, No. 2 ; 4; 1887. Pasternatzky. 

f Gazz. degli ospitali, July 5, 1885. Maragliano. 

X Deutsche Med. Wochensch., No. 48, 1886. 



ANTISEPTICS AND ANTIPYRETICS. 525 

drops, and given up slowly, unchanged, to the blood. Given 
in this way, he finds that thalline causes, 1st. Adipose de- 
generations, particularly affecting the heart and the renal tubules, 
probably due to the deoxydizing influence of the drug. 2d. " Vas- 
cular necrosis," affecting especially the region of the salivary glands 
and slight similar changes in the pancreas ; and 3d. Papillary infarc- 
tion of the kidney, hemorrhagic in character. He found death was 
preceded by muscular tremors, tetanus, and ptyalism, but was al- 
ways able to arrest a fatal termination by administering oxygenated 
oil of turpentine as an antidote to the poison. He has never found 
large doses, in practice, to have had a bad effect, although he has 
given as much as 10 to 15 grammes a day. A number of cases of 
severe rigors have, however, been observed by others, and symp- 
toms of collapse have followed its use. Thalline is eliminated 
chiefly by the urine, to which it imparts a dark green color, and in 
which it can be detected from ^ to 1 hour after being taken.* 
According to some observers f it decreases the quantity of the urine 
passed, while increasing its specific gravity. The elimination of 
carbonic acid is reduced one-half, and the amount of urea excreted 
one-third (Maragliano). 

Medicinal Uses. — Thalline, although probably not preferable 
to either acetanilide or antipyrine, is an antipyretic which promises 
more than either hydroquinone or kairine, and is certainly much 
safer than the latter. It has been used in typhoid fever \ pneumonia, 
pleurisy, diphtheria, measles, erysipelas, and other affections character- 
ized by high fever ; but, like other antipyretics, while lowering the 
temperature, it exerts little if any influence on the course of the dis- 
ease. It would seem to have but little effect in rheumatism or in 
malarial fevers. In phthisis it should be given with caution, as it is 
apt to weaken the patient by tending to increase the colliquative sweats 
(Landenberger), while in debilitated subjects, no matter what the 
disease, care should also be taken for fear of collapse, which is par- 
ticularly apt to occur when the drug is administered to such 
patients.]; It is usually well borne by the stomach. 

Britneff and others recommend a single daily dose of gr. xij- 
xvj, thus obtaining a more intense and prolonged antipyretic effect, 
and only producing one sweat and rigor per day. On the other 

^Wien. Meditz., Wochensch., No. 48, 1884. Von Jaksch ; Maragliano, op. cit. 

f Russ. Meditz., No. 1, 1886, p. 6. Britneff. 

% Russ. Meditz., No. 14, 1886, p. 240. Britneff. 



526 MATERIA MEDICA AND THERAPEUTICS. 

hand, Ehrlich recommends in typhoid fever, small doses (gr. j-iij) 
repeated hourly and rapidly increased until a complete condition of 
apyrexia is produced, which is then to be maintained by the repeti- 
tion of the maximum dose, either until from the symptoms it is 
probable that the disease has run its course, or until the height of 
the fever is past, when he substitutes the hydropathic treatment for 
thalline. 

As an unirritating antiseptic injection thalline sulpahte may be 
used in gonorrhoea, dissolved in water. 

Administration. — Dose, gr.jv-xvj in pills or capsules, repeated 
whenever the temperature tends to rise. 

ANTIPYRINE. 

Antipyrine (not official), a synthetically prepared alkaloid 
which combines readily with acids, forming salts, is a whitish crys- 
talline powder, very soluble in water, with a sweetish bitter taste. 

Imcompatibles. — Spirit of nitrous ether or nitrous acid forms 
isonitroso-antipyrine ; decoctions, tinctures and infusions contain- 
ing cincho tannic acid are precipitated by antipyrine. With strong 
solution of chloral a globular oleaginous precipitate goes down; 
ferric chloride forms a blood-red color. Most of the metallic salts 
form precipitates or colors with this agent. 

Physiological Effects. — Locally it is antiseptic and antifer- 
mentative. The internal action of antipyrine is very similar 
to that of other antipyretic remedies. According to Paster- 
natzki,* it rapidly reduces the temperature in the febrile state, 
acting as do acetanilide and thalline (q. v.) by diminishing nitro- 
genous metamorphosis (thus decreasing heat-production), and by 
regulating heat-distribution (thus increasing heat-radiation), but 
Beyerf found as the result of his carefully conducted experiments that 
this antipyretic action was due entirely to increased heat-radiation 
caused by the extensive dilatation of the veins and capillaries which 
this remedy induces. The perspiration which accompanies the de- 
cline of temperature may be very profuse, but after the period of 
apyrexia, which lasts from four to twelve hours or even longer, the 
return of fever, although sometimes ushered in by a chill, is much 
less apt to be characterized by a severe rigor and even collapse than 
is the case with kairin or thalline. Antipyrine increases to some 

* Op. cit. 

f Am. J. M. Set., Apr., 1886, p. 402. 



ANTISEPTICS AND ANTIPYRETICS. 527 

extent "the power of contraction of both auricles and ventricles" 
(Beyer), and hence is a cardiac tonic. It elevates the arterial press- 
ure to a slight degree. 

In medicinal doses it does not affect the constitution of the 
blood. Like many other antipyretics it depresses the reflexes and 
is analgesic. It is excreted chiefly by the kidneys and may be de- 
tected in the urine for two or three days after its administration has 
been suspended.* Occasionally antipyrine causes a cutaneous 
eruption to appear, usually erythematous but sometimes papular or 
vesicular. 

Medicinal Uses. — Antipyrine is used, as its name implies, as an 
antipyretic, and analgesic agent. For the former purpose it is proba- 
bly more generally employed at present than any other remedy. In 
typhoid fever, when the temperature is high, antipyrine is of the 
greatest value, but it possesses no more power over the disease- 
process than do the other remedies already discussed. In tuber- 
culosis, gr. xv at the onset of the fever, repeated if necessary, will 
be found efficacious, and in acute rheumatism numerous observers 
attest to its good effects, not only in lowering the temperature, but 
also in relieving the pain. It does not, however, lessen the danger 
of cardiac complications, nor the liability to relapse. In sunstroke 
with high temperature it acts most beneficently. It has also been 
advantageously administered in erysipelas, pneumonia, the various ex- 
anthemata, and surgical fever. It is not an antiperiodic, and although 
it may be used to moderate the fever of malarial affections, it will 
not prevent the return of the paroxysm. It is prescribed, too, in 
hay-fever and influenza. 

As an analgesic it is a valuable addition to our armamenta- 
rium. For the purpose of palliating the pain of muscular rheuma- 
tism, lumbago, neuralgia of the superficies, of preventing an attack 
of asthma, in fact as a succedaneum of morphine, Dr. A. Wolff f 
finds, as the result of numerous experiments, in the subcutaneous 
injection of antipyrine, an efficient and quickly-acting remedy, and 
one which is not succeeded by inflammation at the seat of introduc- 
tion. The "lightning pains " of locomotor ataxia are often promptly 
relieved by doses of gr. x-xv repeated as .necessary, and various 
neuralgic affections, as sciatica, tic -douloureux, headache, and other 
nervous conditions characterized by pain (Germain See) are often 

* Revrde'Tfterdp.,M^\is, 1887. Prof. Germain See. 
f Therapeuhsche Monats., No. 6, 1888; quoted. 



528 MATERIA MEDICA AND THERAPEUTICS. 

cured by its timely administration. In muscular rheumatism and 
myalgia it has, too, been used with good results. 

Antipyrine in doses of gr. x-xv will often allay the pain in the 
first stages of labor without apparently interfering with the process 
of dilatation of the os uteri. 

Administration. — Dose, gr. v-5j. The average dose as an 
antipyretic is gr. xv-xxx repeated ; as an analgesic gr. x-xv re- 
peated in from one to four hours if necessary. It may be adminis- 
tered either in aqueous solution or in capsules, or as it is readily 
soluble, by hypodermic injection. 

Many of the essential oils as well as the camphors obtained from 
them have proved to be antiseptic. Among these may be men- 
tioned the oils of cloves, gaultheria, peppermint and thyme (q. v.). 
Menthol, too {v. p. 232), derived from the oil of peppermint is a 
local anaesthetic as well as antiseptic, and has been considered 
under the head of aromatics, but thymol {see p. 535), deserves a more 
extended notice as an antiseptic. 

IODOFORMUM— IODOFORM. 

Preparation and Description. — Iodoform is obtained by the 
action of chlorinated lime upon a heated alcoholic solution of 
potassium iodide, which yields calcium iodate and iodoform, the 
latter being separated by the solvent action of boiling alcohol. It 
is formyl teriodide (CHI 3 ), and occurs in the form of small, scaly, 
yellow crystals, having a persistent saffron-like odor and sweet 
taste, insoluble in water, but soluble in alcohol, ether, chloroform, 
and the fixed and volatile oils. Its molecule contains rather more 
than 95 per cent, of iodine. 

Incompatibles. — With corrosive sublimate. 

Physiological Effects. — Topically, it acts as a germicide, ances- 
thetic and deodorant without irritating the tissues. According to 
Dr. G. R6mmo,* Mikhail, P. Pol'iakoff, and others, the effects of iodo- 
form internally are as follows : Nervous system ; in warm-blooded 
animals, iodoform at first lowers the functional activity of the nerve- 
centres ; voluntary motion is next affected and finally abolished 
(especially in frogs) ; anaesthesia is present to some extent, and the 
reflex functions of the cord are depressed ; the excitability of the 
nerve-trunks to external stimulation is lessened, as is also muscular 

* Arch, de Physiol., 1883. 



ANTISEPTICS AND ANTIPYRETICS. 529 

contractility. A period ensues, if a sufficiently large dose has been 
taken, during which there is excitation of the nerve-centres, with 
clonic and tonic contractions of the muscles. Circulation: the 
capillaries in the web of the frog's foot at first dilate but afterward 
contract. In mammals, a moderate dose primarily retards and 
strengthens the pulse, at the same time slightly elevating the 
arterial pressure from the stimulation of the cardio-inhibitory centre: 
under full doses, the pulse becomes markedly slower and feebler, and 
the blood-pressure falls. Larger doses at first cause slowing of the 
pulse, which, however, becomes quick and irregular, from paralysis 
of the cardiac centre, but this is soon followed by secondary retard- 
ation and final arrest in diastole, from paralysis of the cardiac mus- 
cle. Respiration and temperature : moderate doses cause a rise in 
the temperature from i.8° to 2.7 (in dogs); larger doses produce a 
marked fall of temperature (7. 2° to g° F.) and convulsive respira- 
tory movements. Gastro-intestinal tract : full doses cause vomit- 
ing and diarrhoea (in dogs). Secretion: it increases the salivary, 
biliary, and intestinal flow. Elimination: it is discharged un- 
changed in small quantities by the lungs, but principally leaves 
the system as alkaline sodium iodate, in the urine, which can be 
found one hour after iodoform has been administered and may be 
present for three days. 

Toxicology. — When an excessive dose has been taken, elimi- 
nation is checked, albumen and blood appear in the urine, glom- 
erulo-nephritis and fatty degeneration of the liver, heart and other 
organs occur, and an inflammation of the spinal cord, with results 
similar to acute polio-myelitis, is found. Numerous deaths have 
been reported* from its use as an antiseptic dressing. According 
to Schede and to Kiister the symptoms of poisoning may be divided 
into six classes: 1. In this class of cases high fever is the only 
symptom. 2. Fever with gastro-intestinal irritation, rapid pulse, 
and depressed spirits ; recovery is the rule. 3. Very rapid, com- 
pressible pulse, but no fever; a very dangerous form. 4. Very 
rapid pulse and very high fever; few recover. 5. Great depression, 
collapse, and death; seen especially after severe operations. 6. 
Cerebral symptoms, resembling meningitis. 

Antidotes. — The best preventive to poisoning by iodoform 
consists in remembering that its absorption, even when used exter- 

* La France Med., Nos. 30, et 31, 1882. 

34 



530 MATERIA MEDICA AND THERAPEUTICS. 

nally, is much more rapid than its elimination.- Accordingly, 
should symptoms of poisoning occur, withdraw every particle of 
the adherent dressing, sustain the system with stimulants and 
opium, and give large doses of potassium bicarbonate (Behring*). 

Medicinal Uses. — Iodoform, in the United States, is seldom 
prescribed for internal use. In Europe Bozzolo, following Mole- 
schott, f recommends it highly in diabetes mellitus. He finds that 
the elimination of sugar and the amount of urine are diminished and 
the blood-pressure lowered by the daily use of gr. xv-xxx. In 
the therapy, however of glycosuria, J drugs play a secondary part 
as compared with dietetics. From its action on the circulation it 
is recommended by Moleschott, Testa, and others, in valvular dis- 
eases where the hypertrophy is not compensatory. In these affec- 
tions, given in doses of gr. y^, five or six times a day, it lessens the 
dyspnoea and oedema and increases the urine, the heart beats more 
regularly, and the tendency to hemoptysis disappears. But it is 
not comparable in therapeutic efficiency in cardiac affections to 
digitalis. Numerous observers speak highly of its use in phthisis 
as increasing the body-weight and appetite, diminishing the cough, 
expectoration and night-sweats and slightly lowering the temper- 
ature. It is of more value in the early than in the later stages of 
this disease. As an anthelmintic, it has been used for the destruc- 
tion of tcenia and of asca? r ides, but observers differ as to its value in 
these affections. In the form of vapor it is said to possess anaes- 
thetic properties, inferior, however, to those of chloroform. 

Externally. — It is a local anaesthetic and antiseptic, and for 
this end has been found a good application to chancres, balanitis and 
irritable idcers, bed-sores, etc.; it is used also to relieve the pain of 
cancers, and for these purposes it may be dusted over the ulcerated 
surface, which is then to be dressed with glycerin spread upon lint, 
and it may be powdered over the surface of foul-smelling ulcers, to 
allay their odor. A saturated solution of iodoform in chloroform 
is serviceable in relieving the pain of ?teuralgia and gout ; an iodo- 
form suppository is also useful in painful diseases of the rectum and 
bladder, as hemorrhoids and acute cystitis. Altschul recommends 
iodoform as the most efficacious application for burns of the second 
and third degree; he prefers either an iodoform-gelatin of the 

* Deutsche Med. Wochensch., Jan., 1883. 

f Wien.Med. Wochen., Nov., 1882. 

% See Ralfe's Diseases of the Kidneys for diet suitable to diabetics. 



ANTISEPTICS AND ANTIPYRETICS. 531 

strength of 10 per cent., or better still, an iodoform-paste prepared 
as follows : ty, White wax, oss ; olei olivae, f5j ; liquoris plumbi 
subacetatis, fojv; iodoform, gij-iv. M. As an antiseptic Miku- 
licz * found iodoform to be equal to carbolic acid, and less apt to 
produce constitutional disturbance from absorption. As a dress- 
ing to open wounds, as bubo and fistula, he found it would check 
profuse discharge, prevent decomposition, and stimulate healthy 
granulations. Into suppurating tracts it may be packed with ster- 
ilized cotton. In treating deep wounds he recommends a pencil 
composed of iodoform, I part, with oil of theobroma, 2 parts. The 
smell can be overcome by adding oil of bergamot Tftj, to iodoform 
gr. x. In septic ■, gangrenous, or slougliing wounds it forms an excel- 
lent antiseptic dressing, and is very useful in chronic or irritable leg- 
ulcers. Rommo (pp. cit.) found it more efficacious in preventing the 
appearance of bacteria than in arresting their multiplication. Burman 
speaks highly of a solution of iodoform, §j, to collodion, f§x, painted 
well beyond the line of redness in erysipelas ; and Dr. Tschalovoski 
has seen excellent results follow the application of the powder to 
smallpox pustules, to prevent pitting during the stage of suppura- 
tion. In ophthalmia, in the membranous forms of conjunctivitis , and 
as an antiseptic in ophthalmic surgery, the pure drug, finely pow- 
dered, is highly recommended. Bougies made with iodoform in 
glycerin and gum-acacia, have been passed into the uterine cavity 
(previously washed out with carbolized water) in puerperal fever and 
allowed to dissolve when septicemia was feared ; and it has been 
used as an injection in acute gonorrhoea in the proportion of 5v to 
carbolic acid, gr. jss, glycerin f§ijss, and water f§ss. Only one injec- 
tion should be used per diem for three or four days, after which it 
may be used twice daily. In otorrhcea, with much suppuration, iodo- 
form applied by insufflation to the auditory canal, previously 
cleansed and dried, and retained with a cotton-plug, gives excellent 
results. Theobroma-bougies of iodoform are used in gonorrhoea. 

Administkation. — Dose, gr. j-iij, three times a day, in pill, but 
much larger doses have been given without producing untoward 
effect. The ointment consists of iodoform, 10 parts, rubbed up with 
benzoinated lard, 90 parts. 

ARISTOL. 

The researches for a chemical substance endowed with anti- 
septic properties analogous to those already in use, but not pre- 

* Wiener Med. Wochenschrift, 1881. 



532 MATERIA MEDICA AND THERAPEUTICS. 

senting the inconveniences incident to their employment, has led to 
the discovery of a definite body to which Eichoff has given the 
fantastic name of aristol* (not official), from dpioToc. meaning 
superior. 

Preparation and Description. — Wilgeroth and Vortman ob- 
tained it by adding to powdered iodine a solution of thymol in 
an aqueous ammoniacal mixture of alcohol, which yielded an 
oily precipitate, and the distillation of the vapor in acetic acid and 
crystallization gave thymol moniodide, that is, one atom of iodine 
had replaced one atom of hydrogen in thymol. By further 
treatment with iodine the moniodide was made to take up an 
additional atom of iodine and aristol or dithymol iodide (C 10 H 12 HIO 2 ) 
resulted. It is an amorphous reddish-brown powder, inodor- 
less, insoluble in cold water and glycerin, slightly miscible in 
alcohol, more so in ether and chloroform, and completely blends 
with the fixed oils, as vaseline. 

Incompatibles. — Aristol is not an entirely stable body since it 
parts readily with its iodine under the influence of moisture and 
light, passing to the moniodide, hence it should be preserved in 
yellow vials, and prescribed alone, though it mixes well with tannic 
and gallic acids. It is incompatible with the carbonates, starch and 
corrosive sublimate. 

Physiological Effects. — -The action of aristol has not yet 
been investigated and for the present we must be content to know 
little beyond the fact that while it exerts a destructive influence 
upon certain bacteria, not including the bacillus anthrax, it is 
neither toxic nor irritant when applied to wounds. Upon dogs the 
subcutaneous injection of an oily solution is not poisonous even to 
the extent of gr. 45 per 2^ lbs. of body-weight. Introduced 
within the economy it is eliminated in part at least by the urine 
under the form of an alkaline iodide though only about half the 
quantity injected passes out by this channel, and none at all as 
thymol. The points of injection do not become the seat of inflam- 
mation. 

Medicinal Uses. — Aristol has been scarcely exhibited intern- 
ally. It is rather as a local succedaneum of iodoform that it has been 
brought to notice, over which it possesses the advantage of being 
odorless, unirritating and harmless. Those who have used it laud 

* Bull. Gen. de Th'erap., Egasse, 1890. 



ANTISEPTICS AND ANTIPYRETICS. 533 

it highly as an antiseptic and cicatrant in the treatment of ulcers and 
cancers. It has been applied to such an intractable affection as 
lupus with benefit, care being taken to first snip off the tuberculous 
ulceration. A number of cases, too, of its successful employment in 
otorrhea with much suppuration are reported, the auditory canal being 
cleansed previous to the introduction of the remedy : this should 
be done by insufflation, and the medicament retained with a cotton- 
wad. The same method of treatment in chronic nasal catarrh with 
scanty and stagnant secretions has given good results. But it is 
not adapted to acute nasal catarrh, the nasal mucous membrane not 
well tolerating the drug. It has been also employed to aid the 
cicatrization of epithelioma. Rather more experience and statistics 
will be required, however, to assign to this new remedy its proper 
therapeutical place. 

Administration. — Topically, in ethereal solution I to 10 of 
fluid; with collodium, I to 9; a pomade 1 part to olive-oil 2 parts, 
and lanolin 7; in suppository gr. 15 to cacao-butter q. s. 

IODOL. 

Preparation and Description. — Iodol (not official) is ob- 
tained by the action of iodine on pyrol (QH 4 NH) a constituent 
of animal oils,* in which iodol or tetra-iodo-pyrol (QI^NH) is 
formed by the substitution of 4 atoms of iodine for 4 atoms of 
hydrogen. It is a " light-yellowish-gray, fine and specifically light 
powder," soluble in 5000 parts of water, in 3 parts of alcohol, and 
in about its own weight of ether. The addition of water to the 
alcoholic solution causes a milky precipitate. It is very rich in 
iodine, containing 88.9 per cent. It has very little taste, and is free 
from disagreeable odor. 

Physiological Effects. — When in contact with the tissues and 
secretions of the body iodine is readily liberated, but no constitu- 
tional phenomena have attended its long-continued use as an ex- 
ternal application, f Introduced within the stomach it gives rise to 
phenomena similar to those of iodoform, though less toxic. It is 
slightly caustic, adhering readily and uniformly to the surface of a 
wound, and forming a gray protective film to the granulations under- 
neath. It is said to aid the process of cicatrization. % Its antiseptic 

* Lancet, Nov., 1885, p. 1013. 

■\ Practitioner, May, 1887, p. 336. R. N. Wolfenden. 

J Bull. Gen. de Th'erap., Fev., 1887. Dr. Juquer. 



534 MATERIA MEDICA AND THERAPEUTICS. 

power against the microbes of suppuration described by Fournioux, 
which is due to the liberation of iodine, is about equal to that of 
iodoform, to which it is preferable from its comparative freedom 
from nauseous smell and taste and the absence of toxic symptoms 
attending its external use. Even when applied freely to wounds of 
extended surface with much loss of substance, according to Egasse,* 
although dissolved by the secretions and absorbed, no symptoms of 
poisoning have been observed, as is so often the case with iodoform. f 
Whether used locally, or administered internally, its presence can 
shortly be detected in the saliva and urine. 

Medicinal Uses. — As an external application it has been ex- 
tensively used in the treatment of chancres, suppurating buboes, and 
also in simple indolent ulcers with good results, and in no case has 
any erysipelatous or diphtheritic inflammation been observed. Dr. 
Petersen, of St. Petersburg, however, applying it as a dusting pow- 
der to chancroids three or four times daily, observed that usually 
about the third day the granulations became flabby, "as if hyaline," 
and that the granulation-process was , retarded. Iodol has been 
much lauded as a substitute for iodoform in ophthalmic practice, par- 
ticularly in the chronic forms of conjunctivitis and in sluggish corneal 
ulcersX but it is contraindicated in affections of acute irritative charac- 
ter. According to Katzauroff, iodol always caused much more irri- 
tation than iodoform, when the powder was applied to a healthy eye, 
and it did not prove as useful in his hands, except in phlyctenular con-- 
junctivitis , trachoma and opacities of the cornea, in which it was of 
great service. 

In nasal, laryngeal and pharyngeal affectio?is it is highly recom- 
mended, particularly in laryngeal phthisis, in which it is often of sig- 
nal value (R. N. Wolfenden). Internally, it has been used as a sub- 
stitute for iodoform. 

Administration. — Dose, gr. J^-ij, in capsule, pill or solution. 
Locally to the eye or throat, it is used in powder or in alcoholic solu- 
tion diluted with glycerin (iodol I part, alcohol 16 parts, glycerin 34 
parts), and to wounds in powder, solution, ointment (1 or 2 per 
cent), bougies, wool or gauze. 

* Bull. Gen. de Therap., t. 2, 1890, p. 443. 
•j" Compt. Rend. Soc. de Biol., Paris, 1890, ser. 9, p. 406. 

XL' Union Med., Mars 22d, 1886 ; Annates d 1 Oculist, Mai, Juin, Juillet et Aout, 1886. 
Dr. Trousseau. 



AATISEPTICS AND ANTIPYRETICS. 535 

THYMOL. 

Preparation and Description. — Thymol (C 10 H 13 HO), called 
also cymylic phenol, is a solid crystalline stearopten found in the 
volatile oil {oleum thy mi) distilled from thymus vulgaris {vide p. 233). 
It is separated by fractional distillation ; that portion of the oil which 
distils above 392 F. is agitated with a Concentrated solution of 
caustic soda, and the thymol liberated from the resulting solution 
by hydrochloric acid. It is purified by rectification, and occurs as 
large, colorless, rhombohedral crystals, having an aromatic odor 
and a hot, aromatic taste; slightly soluble in water, but very 
soluble in ether and alcohol. 

Effects and Uses. — Thymol is a powerful antiseptic. Its 
effects are analogous to carbolic acid, and like that agent, when 
locally applied it produces paralysis of the cutaneous end-organs of 
the sensory nerves (Lewin). When given internally in full doses it 
produces tinnitus aurium, deafness, reduction of temperature, often 
diarrhoea, and sometimes nausea and, vomiting. In several cases 
its ingestion caused violent delirium and collapse; profuse dia- 
phoresis took place, and the urine was of a dark green color, but 
free from albumen ; the sweating was not as marked as that pro- 
duced by salicylic acid, nor was the antipyretic effect as great. As 
an antiseptic in inflammations and ulcerations of the mouth, as 
stomatitis, it is very useful, and it has been been employed as an 
inhalation (gr. vji to warm water f§j) to diminish the expectoration 
o>{ phthisis, etc. It is one of the best intestinal antiseptics and may 
be used in amounts varying from gr. v-x internally in abnormal 
conditions of the intestine attended with putrefactive changes in the 
chyme. It is recommended by Bufalini in diabetes mellitus in con- 
junction with the exclusive proteid diet of diabetic patients to 
prevent the gastro-intestinal disturbance which commonly ensues 
sooner or later upon the withdrawal of the carbohydrates, as well 
as to prevent or remove when present, the symptoms due to 
acetonemia. Locally it is used to fulfil the same indications as car- 
bolic acid. Da Costa recommends crystallized thymol as a gargle 
in diphtheria. Dose, gr. j-x ; as a spray, I to 800 of warm water. 

icthyol. 

This substance (not official) first described in 1882 by Schroet- 
ter, and only recently introduced to the profession, derives its name 
from c/doz, fish and oXsiou, oil. 



536 MATERIA MEDIC A AND THERAPEUTICS. 

Preparation and Description. — Its chemistry and action 
have been carefully described by £gasse * and Charles. f It is 
procured by the dry distillation of a kind of sulphurated bituminous 
mineral found in the Tyrol, which contains fossil-fish, and marine 
animal remains in abundance. By this process an oily substance is 
obtained, which yields on rectification a greenish fluorescent body 
containing about 2 T / 2 per cent, of sulphur, which when treated with 
H 2 S0 4 and neutralized furnishes a new product. This product 
combines readily with the alkalies, as well as zinc, mercury, etc. 
With ammonia it forms an icthyolate, or icthyol, a thick, fluid, 
stable, fatty-looking substance, of a brownish-black color, and of a 
strongly bituminous taste and smell, readily miscible with oils, 
(except olive), vaseline, chloroform, or ether and alcohol mixed, but 
only slightly so in ether, or alcohol alone. It is soluble in water 
though a resinous deposit goes down on standing. 

Incompatibles. — On account of its reducing properties, it 
should not be mixed with remedies that part readily with oxygen, 
as potassium permanganate.* 

Aids. — Boric acid, salol, and the tarry preparations. 

Physiological Effects. — The action of icthyol has not yet 
been completely studied. When given to dogs, in small quantities 
(5j/^) it is innocuous, but in doses of from Siij-jv, it induces pro- 
longed diarrhoea, hence it may be considered in lethal amounts as 
a gastro-intestinal irritant. As to whether it exerts any influence 
upon the cerebro-spinal system and temperature, no observations 
have been recorded. In feeble doses, it manifests a decided con- 
tracting influence upon the calibre of the arteries, veins and capil- 
laries due, according to Unna, but denied by others, to its property 
of withdrawing oxygen from the tissues when brought in contact 
with them, by which the external coat of the vessel is kreatinized, 
and not to a narrowing of its calibre. In large amounts it is stated 
to bring about an abundant migration of the white corpuscles 
from the vessels. Some recent experiments by Fessler, show that 
icthyol possesses antiseptic properties, at least against certain kinds 
of microbes ; moreover its power of abstracting oxygen from the 
tissues should place it among the agents that hinder the develop- 
ment of aerial pathological germs. 



* Bull. Gen. de Tfierap., 1891, p. 49. 
f Lancet, London, Sept. 26, 1891. 



ANTISEPTICS AND ANTIPYRETICS. 537 

Medicinal Uses. — So far the employment of icthyol, has been 
almost entirely limited, as a weak antiseptic, to external exhibition 
particularly in dermal therapeutics, as erythema, acne, eczema, and 
herpes coster. It has however, been prescribed topically in neuralgia 
of the 5 th pair of nerves, and to sprains and chilblain. In erythema 
its employment is advised when there is much hyperemia in the form 
of soap and hot water or perhaps ointment, and the same measures 
are suitable to acne used with friction. A 3 per cent, solution in a 
mixture of alcohol and ether, is employed in neuralgia to be applied 
with a brush. The form of eczema, which it seems best suited to is 
eczema rubriim ; for the ordinary acute eczema it is not adapted. In 
spite of the favorable reports obtained by some practitioners with 
this remedy it must be admitted that it is still on trial, and that 
frequently disappointment will follow the result of its exhibition. 

Administration. — 'For internal use the dose varies for adults 
from gr. viij to 5j, in 24 hours given in capsule; for local use it may 
be made up with lanolin or vaseline, 52^ to the 5 or stronger; 
or it may be dissolved in a mixture of alcohol and ether. 

DERMATOL. 

This recent addition to the materia medica, introduced by 
Heintz, is bismuth gallate (not official). It occurs as a fine, odor- 
less, saffron-colored powder, unaffected by light or air, and is in- 
soluble in the ordinary menstrua. 

Effects and Uses. — Antiseptic virtues are claimed for this 
medicament which are, however, weaker than those of iodoform, and 
it is stated to be astringent and unirritating, and to possess absorbent 
powers. It is not toxic. Dermatol is said to hasten the cicatriza- 
tion of ulcers and chancroids, and satisfactory results are stated to 
have followed its use as a deodorizing-antiseptic application to 
balanitis, suppurating buboes and acute eczema. It is a good dust- 
powder in moist eczema. 

Administration. — Never internally. Topically in powder, or 
dermatol 10, lanolin 20, and vaseline 70 parts; it mixes well with 
zinc oxide, and starch. 

carbo ligni— charcoal. 

Although not strictly ranking with antiseptics, the medicinal 
uses of charcoal may, perhaps, be appropriately noticed under this 
head. 

Preparation and Description. — Charcoal is prepared by the 



538 MATERIA MEDIC A AND THERAPEUTICS. 

exposure of wood to a red heat without access of air. For medi- 
cinal purposes the charcoal prepared from young willow shoots for 
the manufacture of gunpowder is preferred. It is a black, shining, 
brittle, porous substance, without odor or taste, and insoluble in 
water. 

Effects and Uses. — It is not absorbed from the intestinal tract, 
being discharged with the feces without action upon the economy. 
It is employed internally as an absorbent of acrid secretions and 
gases, in dyspepsia (in which it is often very useful), eructations, 
in gastric irritation, diarrhoea and dysentery. 

Administration. — Dose, from one to four teaspoonsful. Ex- 
ternally it is used with effect to absorb the offensive gases given off 
from foul sores, in the form of poultice (vide poultices), mixed with 
flaxseed meal, or with bread-crumb, which is better from its poro- 
sity ; dry charcoal is sprinkled with advantage over sloughing ulcers, 
and it appears to promote the separation of the sloughs. 

ORDER III.— IRRITANTS. 

Irritants are medicines which are employed to produce irrita- 
tion or inflammation of the parts to which they are applied. They 
may be subdivided into Rubefacients, Epispastics, Suppurants, 
and Escharotics. Rubefacients are used merely to produce red- 
ness of the skin. Epispastics, Vesicants, or Blisters, cause the trans- 
udation of a serous fluid under the cuticle. Suppurants produce a 
crop of pustules. Escharotics exert a chemical action on the tissues 
with which they are placed in contact, and decompose or destroy 

them. 

rubefacients. 

Rubefacients are employed to remove congestion and inflam- 
mation, to rouse the capillary system in cases of local torpor, to 
relieve pain and spasm, and as stimulants to the general system in 
coma, syncope, asphyxia, etc. They are adapted to cases in which 
a sudden and powerful, but transient action is called for; but they 
may be employed where a slight and long-continued action is de- 
sired. In removing congestion and inflammation, rubefacients act 
by stimulating the capillary vessels of inflamed parts, and thereby 
restoring their tone and elasticity. That they can influence dis- 
tant organs was pointed out by Brown-Sequard, who called atten- 
tion to the fact that when the skin over the kidneys was irritated 
the renal arteries contracted, hence we can understand what im- 



IRR I TA NTS— MUSTARD. 



539 



portant service a rubefacient, as a mustard-plaster, may render, in 
conditions of renal hyperemia. They are useful chiefly in the form- 
ing stages or in light grades of inflammation. They are very ser- 
viceable local anodynes when applied to painful parts — acting by a 
substitutive influence. As general stimulants, their efficacy in rous- 
ing the system depends partly on their action on the capillary cir- 
culation, and partly on the pain which they produce. They are 
most valuable in the coma or asphyxia resulting from poisons, 
drowning, etc., and are inferior to blisters in the cerebral oppression 
which occurs in fevers, inflammation of the brain, etc. 

Rubefacients are usually applied till pain and redness supervene. 
If kept too long on the skin, many of them will produce vesication 
and even gangrene; and in cases of coma particularly, caution is 
required, as the patient may not feel them till dangerous inflamma- 
tion has occurred. 

SINAPIS ALBA— WHITE MUSTARD. » 
SINAPIS NIGRA— BLACK MUSTARD. 

Mustard seeds are obtained from two varieties of Sinapis — S. 
nigra, or Black Mustard, and S. alba, or White Mustard (Nat. Ord. 



Fig. s 4 . 




SINAPIS ALBA ; A. SEED ; B. SEED-POD. 



Cruciferae), small annual European plants, cultivated in our gardens. 
S. nigra has become naturalized in some parts of the United States. 



540 MATERIA MEDIC A A AD THERAPEUTICS. 

Description. — Black mustard seeds are small, globular, of a 
deep brown color externally, and internally yellow. They are 
inodorous, except in powder; and when rubbed with water exhale 
a very strong, pungent smell. Their taste is bitterish, hot, and 
pungent. White mustard seeds are larger, yellowish externally, and 
of a less pungent taste, owing to the presence of a mucilaginous sub- 
stance in their skin. The powder of both varieties (commonly called 
flour of mustard) is yellow, and is often adulterated with colored 
wheaten flour. Both varieties yield their virtues wholly to water, 
and very slightly to alcohol. 

Chemical Constituents. — Mustard seeds yield, upon pressure, 
a fixed saponifiable oil, which contains oleic acid and a peculiar acid 
termed erucic (HC 22 H 41 2 ). From the black seeds a very pungent 
volatile oil, containing sulphur, is afterwards obtained by distillation ; 
it does not pre-exist in the seeds, but is the residt of the action of water 
upon a peculiar principle called sinigrin or potassium myronate (C 10 - 
H 18 NS 2 KO 10 ), which is split into allyl sulphocyanide (C 3 H 5 CyS), acid 
potassium sulphate (KHSOJ, and sugar (C 6 H 12 6 ). This oil is 
colorless or pale yellow, rather heavier than water, of a pungent 
odor and of an acrid, burning taste. Allyl sulphocyanide is the 
principle to which the black seeds owe their activity. From the 
white seeds no volatile oil is obtained; but when treated with water 
they yield an acrid fixed principle, which is analogous in properties 
to the volatile oil of the black seeds. // is the result of the reaction 
of zvater upon sinalbin (C 30 H 44 N 2 S 2 O 16 ), a peculiar ingredient of the 
white seeds, which is decomposed into acrinyl sulphocyanide (C 8 H 7 - 
NSO), sinapine sulphate (C^H^NSOg), and sugar (C 6 H 12 6 ). The 
development of the volatile oil in the black seeds, and of the acrid 
fixed principle in the white seeds, is supposed to depend upon the 
presence of an albuminous constituent called myrosin, which acts 
the part of a ferment in determining a reaction between water and 
the peculiar principles of the seeds. Myrosin is rendered inert by 
heat, alcohol, and the acids; and water, of the ordinary tempera- 
ture, is therefore the proper menstruum of mustard. 

Effects and Uses. — Mustard is an acrid stimulant In small 
quantities it is stomachic; in larger doses it proves emetic; and in 
excessive doses it will produce gastro-enteric inflammation. When 
applied \.o the skin it is a rapid and powerful local excitant, speedily 
producing redness and pain, and if long continued, vesication, ulcera- 
tion, and even sphacelus. Mustard seeds, swallowed whole, have 



IRRITANTS— MUSTARD. 541 

been used as a laxative in dyspepsia, in the dose of a tablespoonful 
once or twice a day, mixed with molasses ; the white seeds are pre- 
ferred ; the practice is, however, of doubtful value, as they may be- 
come entangled in the appendicula vermiformis. When mustard is 
employed internally, however, it is chiefly as an emetic, in cases of 
torpor of the stomach, particularly after narcotic poisoning ; and by 
its stimulant action, mustard often arouses the gastric suscepti- 
bility when other emetics fail. 

The most general use of mustard is, however, as a cutaneous 
stimulant or mbefacient-poultice in the form of cataplasm (termed 
a sinapism). This is made by mixing flour of mustard with a suffi- 
cient quantity of tepid-water to give it proper consistence, and it 
may be diluted with wheat-or rye-flour if a weaker effect is desired. 
Sinapisms are used when a speedy and powerful rubefacient effect 
is required. They are applied to the nape of the neck as a counter- 
irritant in apoplexy to restore consciousness, to the same region in 
cerebral meningitis during the stage of excitation; to relieve the 
pains of muscular rheumatism, myalgia, and to the sterno-mastoid 
muscle in torticollis. The application of a sinapism is a valuable 
counter-irritant to the integument of the throat in croup, acute laryn- 
gitis, hoarseness, and to the chest in acute bronchitis. In intestinal 
disorders, as duodenal catarrh, colic, cholera morbus, and cholera, the 
effects of mustard applied to the epigastrium or abdomen, for the pur- 
pose of checking vomiting and relieving cramp, are most valuable. 

Mustard diffused through warm water in which the feet and 
legs are soaked is a popular revulsive remedy at the onset of bron- 
chitis, fever, headache, etc. In the form of a warm sitz-bath in delayed 
menstruation, taken at the time the period is due, it will often reestab- 
lish the flow. Sinapisms should be kept on till pain and redness 
are produced, usually from a quarter of an hour to an hour, and in 
cases of insensibility their effects should be carefully watched. 
They are applied spread on linen, and covered with gauze to prevent 
adhesion to the skin. Mustard is the most active and at the same 
time the most easily controlled of the rubefacients; a mild but per- 
manent effect may be kept up by the addition of a teaspoonful to a 
tablespoonful of mustard to a poultice of Indian meal or flaxseed, 
with a tablespoonful or two of capsicum. 

For ready use there is now kept in the shops charta sinapis 
(mustard-paper), which is prepared by mixing black mustard (in 
powder) with enough solution of gutta-percha to give it a semi- 



542 MATERIA MEDICA AND THERAPEUTICS. 

liquid consistence, and then applying the mixture by a brush to a 
piece of stiff paper; each square inch contains about gr. vj. of mus- 
tard. Before being applied to the skin it should be dipped for about 
fifteen seconds in lukewarm water. 

Administration. — The dose of mustard, as an emetic, is from a 
large teaspoonful to a tablespoonful of the bruised seeds or powder. 
Its use in smaller quantity, as a condiment and stimulant of the diges- 
tive organs, is well known. In the form of whey (§ss boiled in milk 
Oj) it has been given as a diuretic in dropsy. 

Oleum sinapis volatile {volatile oil of mustard), the volatile oil ob- 
tained from black mustard by maceration with water and subsequent 
distillation, possesses the properties of mustard. It is very irritant. 
It is used in making — 

Linimentum sinapis compositum {compound liniment of mustard), 
which is composed of volatile oil of mustard (3 parts), extract of 
mezereum (2 parts), camphor (6 parts), castor-oil (15 parts), and 
alcohol (enough to make 100 parts by weight). 

A mixture of oil of mustard, chloroform and camphor, under 
the name of Nervol, is used with good effect for the relief of tooth- 
ache, by rubbing a few drops on the cheek. 

CAPSICUM. 

Capsicum has been previously noticed as an aromatic stimulant 
(see p. 223). It is an efficient rubefacient, useful in rheumatism, low 
fevers, etc.; the plaster, tincture, or oleo-resin may be used. 

OLEUM TEREBINTHIN^-OIL OF TURPENTINE. 

The Oil of Turpentine (see index) is a speedy and efficacious ru- 
befacient, and sometimes produces a vesicular eruption. It is em- 
ployed in low forms of disease attended with coldness of the surface; 
as a counter-irritant in inflammation ; and as a stimulating liniment 
in rheumatic and paralytic cases. It is often diluted with olive-oil. 

LINIMENTUM AMMONIA— LINIMENT OF AMMONIA. 

This preparation, called also Volatile Liniment, consists of 30 
parts of water of ammonia (see p. 22 1, et sea.) and 70 parts of cotton- 
seed oil. It is an excellent application, as a counter-irritant, in 
affections of the throat and chest, etc. 

PIX BURGUNDICA— BURGUNDY PITCH. 

This is the prepared resinous exudation from Abies excelsa, 
or Norway Spruce {Nat. Ord. Coniferae), a lofty evergreen tree of 



IRRITANTS-CANADA PITCH. 543 

Europe and northern Asia. Abies picea, or the European Silver 
Fir, is said to be also a source of the drug. 

Preparation and Constituents. — It is obtained by stripping 
off the bark and detaching the flakes of resinous matter which form 
upon the surface of the wound; they are afterwards melted in boil- 
ing water and strained. Burgundy pitch is collected principally in 
Germany and France, and derives its name from Burgundy, in the 
latter country. After it is imported into the United States it is 
generally re-melted and strained to free it from impurities; and as 
found in the shops it is a hard, brittle, opaque substance, of a yel- 
lowish or brownish-yellow color and a weak terebinthinate taste 
and smell; when applied to the body it softens and becomes adhe- 
sive. It contains resin and a much smaller proportion of volatile oil 
(C 10 H 16 ) than turpentine. 

A spurious Burgundy pitch is made by melting together pitch, 
resin and turpentine, and agitating the mixture with water. 

Effects and Uses. — This is a gentle rubefacient, producing a 
slight degree of inflammation and serous effusion, without separating 
the cuticle. It occasionally produces a papillary or vesicular erup- 
tion; and sometimes, though rarely, occasions painful vesication 
and even ulceration. It is applied in the form oi plaster to the chest 
in chronic and subacute pulmonary disorders, as bronchitis, to the 
loins in lumbago, to the joints in chronic articular affections, and for 
the relief of local rheumatic pains. 

Emplastrum Picis Burgundicce [Burgundy pitch-plaster) consists 
of 80 parts of Burgundy pitch melted with 10 parts of yellow wax, 
which is used to give consistence to the pitch. Emplastrum picis 
cum cantharide {pitch-plaster with cantharides) consists of 92 parts 
of Burgundy pitch melted with 8 parts of cerate of cantharides : this 
is commonly called the warming plaster, and is a more active rube- 
facient than Burgundy pitch, though it does not usually blister. It 
is a useful application in myalgia, lumbago and bronchitis. The iron- 
plaster, galbanum-plaster and opium-plaster all contain Burgundy 

pitch. 

pix canadensis-canada pitch. 

This is the prepared resinous exudation from Abies cana- 
densis, or Hemlock Spruce (Nat. Ord. Coniferse), a very lofty ever- 
green tree of Canada and the northern part of the United States. 

Preparation and Constituents. — The pitch (sometimes called 
hemlock-guni) is a spontaneous exudation on the old trees. The 



544 MATERIA MEDIC A AND THERAPEUTICS. 

portions of bark upon which it hardens are stripped from the tree 
and boiled, and the melted pitch is skimmed from the surface of the 
water. It undergoes a further purification in the shops by melting 
and straining, and is found in hard, brittle, opaque masses, of a dark 
yellowish-brown color, a weak, peculiar odor and scarcely any taste. 
It is more readily softened by heat than Burgundy pitch, and is, 
therefore, sometimes a less convenient application. Its constituents 
are resins and a minute portion of volatile oil. By Maisch the 
spruce gum of the shops is said to be the product of Abies nigra. 
Its effects and uses are the same as those of Burgundy pitch. 

Emplastrum Picis Canadensis {Canada pitch-plaster), sometimes 
called hemlock pitch-plaster, consists of 90 parts of Canada pitch 
melted with 10 parts of yellow wax. 

Many other substances are occasionally employed as rubefaci- 
ents. Ginger [vide p. 227), Black Pepper (vide p. 224) and Garlic 
(vide index) are particularly deserving of mention. A gentle 
counter-irritant, often used to the epigastric region to relieve vomit- 
ing, is the spice-plaster, which is made by mixing Sij of powdered 
ginger with 5j of powdered cloves and cinnamon, each, and 3ij of 
capsicum, adding f§ss of tincture of ginger and honey enough for 
proper consistence. 

EPISPASTICS. 

Epispastics, called also Vesicants and Blisters, are medicines 
which, when applied to the skin, produce inflammation, accom- 
panied by effusion of serum beneath the cuticle. Many of the rube- 
facients will blister if kept on the skin a sufficient length of time; 
and, on the other hand, the action of vesicants may be made not to 
extend beyond rubefaction. The first effect of a vesicant when ap- 
plied to the integument is to redden the skin, the superficial vessels 
becoming dilated, and a sense of burning is set up in the part. If 
the irritation be continued serum, plasma and corpuscles begin to 
ooze from the vessels, the epidermis is raised and a vesicle is 
formed, varying in size according to the extent of the exciting cause. 
Considerable local pain now ensues, and should the irritation be 
sufficiently severe or prolonged, a crop of pustules appears. The 
inflammation of the skin caused by vesicants is erysipelatous in its 
character, and may result in sloughing or gangrene. In inflamma- 
tion of the dermoid tissues, as rubeola and scarlatina, in typhus under 



IRRITANTS— CANTHARIDES. 545 

certain circumstances, in debilitated conditions of the system, and 
in extreme infancy, vesicants may produce serious consequences. 

This class of agents is employed — I. As local stimulants, in 
the cure of internal inflammations as chronic synovitis, gonorrheal 
and chronic rheumatism. Different explanations have been offered 
of the antiphlogistic influence of blisters, some therapeutists ascrib- 
ing it to a derivative or revellent action, by determining vascular and 
nervous energy to the seat of their operation, but it is more pro- 
bably due to a stimulant effect extended to the capillary vessels of 
the inflamed organ, and experience has shown that, for the relief of 
internal inflammation, they cannot be applied too near the affected 
organ. In affections of the head and spine, blisters are pre-eminently 
useful, meningitis cerebral and spinal for example. 2. To substitute a 
healthy therapeutic inflammatory action, which subsides spontane- 
ously, for a morbid action existing in the part to which they are 
applied. In this way vesicants are used for the cure of various 
cutaneous eruptions, particularly chronic eczema. 3. To relieve 
pain, which they do partly by a stimulant and partly by a substitu- 
tive influence. 4. To break up a train of morbid associations by 
the powerful impression which they make on the nervous system, 
as in the cure of spasmodic diseases, etc. 5. To stimulate the ab- 
sorbing or secreting vessels of parts contiguous to the seat of their 
application; in this way they are useful in promoting the absorption 
of dropsical effusions, in the treatment of ununited fracture, etc. 
6. As general stimulants, in typhoid conditions of the system, coma, 
syncope, etc. 7. As local stimulants, in threatened gangrene, par- 
alysis, facial palsy, sciatica, etc. 8. As evacuants, chiefly for the 
purpose of local depletion. 9. In retrocedent gout, and in retroces- 
sion of the exanthematous eruptions. 10. To prepare a surface for 
the endermic application of medicines. 

CANTHARIS-CANTHARIDES. 

Cantharis vesicatoria, termed also Lytta vesicatoria, the Span- 
ish Fly {Class, I.nsecta ; Order, Coleoptera), is a cylindrical insect, 
from six to ten lines in length by two or three in breadth, with a 
large cornate head, an oblong body, and elytra, or wing-cases, of a 
beautiful, shining, golden-green color. 

Habitat and Collection. — It is found most abundantly in 
Spain, Italy and the south of France, but occurs in all the temper- 
ate parts of Europe, and in western Asia. The Spanish flies swarm 
35 



546 MATERIA MEDIC A AND THERAPEUTICS. 

on certain trees and shrubs, and may be detected at a considerable 
distance by their strong fetid odor, which resembles that of mice. 
They make their appearance in May and June, and are collected in 
these months by persons protected by masks and gauntlets, who 

Fig. 55. 




CANTHARIS VESICATORIA. 



beat or shake them from the trees on which they lodge, and receive 
them, as they fall, upon linen cloths spread underneath. They are 
plunged into hot vinegar and water, or exposed to the vapor of 
boiling vinegar, and are afterwards dried in the sun or by drying- 
stoves. When perfectly dry they are packed in canisters, which are 
carefully closed so as to exclude air and moisture. They are 
usually imported into this country from some Mediterranean port. 
A highly-esteemed variety comes from south Russia, through St. 
Petersburg, which is distinguished by the large size and copper- 
color of the flies. 

Description. — In the dried state, cantharides retain their form, 
color, odor, etc. ; their taste is acrid, burning and urinous ; their 
powder is of a grayish-brown color, interspersed with shining green 
particles. If exposed to moisture they are soon decomposed, most 
speedily when powdered. As, moreover, the powder is liable to 
adulterations, they should be always purchased whole, and should 
be powdered as they are wanted for use. They are liable to be at- 
tacked by mites, which destroy the interior soft parts : the best mode 
of preserving them is to expose them, in bottles, to the heat of 
boiling water, which destroys the eggs of the insect. A little cam- 
phor or ammonium carbonate, or a few drops of acetic acid or of 
chloroform, added to the flies, are also recommended as preserva- 
tives. 

Chemical Constitutents. — The most important constituents of 
cantharides are a volatile oil, upon which the odor depends, and a 



IRRITANTS— CANTHARIDES. 547 

neutral crystalline substance, termed cantharidin (C 10 H 12 O 4 ), which 
is the vesicating principle. Cantharidin is inodorous, tasteless, solu- 
ble in ether, chloroform, the oils, acetic acid, and boiling alcohol, 
and nearly insoluble in cold water and alcohol ; but notwithstanding 
the insolubility of cantharidin, watery and alcoholic solutions of 
cantharides possess the medicinal properties of the insect, — the can- 
tharidin being rendered soluble by combination with a yellow col- 
oring matter in the insect. By the aid of heat, in the presence of 
water, cantharidin may be made to combine with the alkalies, being 
converted into cantharidic acid. 

Aids. — Internally as an aphrodisiac, phosphorus, and strychnia; 
topically, the vesicants, as aqua ammoniae fortis, sinapis, etc. 

Contraindications. — Acute renal inflammation ; in debilitated 
subjects blisters may excite sloughs ; applied to the recumbent parts 
of bed-ridden people there is danger of making bed-sores. 

Physiological Effects. — The activity of cantharis depends on 
the presence of cantharidin. Applied to the skin, cantharides pro- 
duce inflammation which terminates in the secretion of serum under 
the cuticle in the form of vesicles which unite to make in 7 to 10 hours 
a large bulla. Even when they are externally applied their constitu- 
tional effects, as strangury, tenesmus, etc., are frequently manifested. 
Cantharides are an acrid stimulant. Taken internally they irritate 
the mouth and fauces, and reaching the stomach they produce a 
sensation of heat and gastrodynia, all more or less emphasized ac- 
cording to the amount swallowed. Cantharidin rapidly passes into 
the blood, augmenting the secretion of the kidneys, and in large 
amounts produces irritation of the genito-urinary passages, 
which is evinced by strangury, priapism, pain and occasionally 
the discharge of bloody urine. Erotic excitement does not, 
however, always follow the ingestion of cantharides. Palle* has 
recorded his observations on this point, obtained by questioning 
a number of men who had taken the drug, and in none was 
amatory desire present. Christison affirms the same thing while 
Pereiraf holds to the contrary. It would seem most probable 
that only small doses are likely to prove aphrodisiac, large ones be- 
ing too violent to admit of such action. In full doses cantharides 
excite the heart and quicken the pulse and respiration. GalippeJ 

* Journ. de Pharm. et de Chimie, 13, 1871, p. 431. 

f" Mat. Medica.," Vol. II. 

I Gaz. Hebdom., 1874, 2d ser., p. 438. 



548 MATERIA MEDICA AND THERAPEUTICS. 

found that when injected into animals the chief symptoms were dy- 
suria, hematuria, vomiting, dilatation of the pupil, enfeebling of the 
general sensibility, collapse and death. The chief post-mortem 
lesions were inflammation of the digestive tube, kidneys, and blad- 
der. 

Toxicology and Antidotes. — In large doses they produce 
violent gastro-enteric and genito-urinary inflammation; and in 
excessive doses prove fatal, with convulsions, tetanus, delirium, and 
other cerebro-spinal symptoms. Twenty-four grains* have occa- 
sioned death, while recovery has followedf the swallowing of f 5 yj of 
the tincture. In cases of poisoning, after the stomach has been 
emptied, opiates, demulcents and stimulants are to be resorted to, but 
oils are to be avoided, as cantharidin is soluble in this menstruum. 

Medicinal Uses. — The indications which cantharides are capa- 
ble of fulfilling, when administered internally as a diuretic, emmen- 
agogue, etc., have been already noticed (see index). Their chief 
use is as an external application, to produce blisters (see Epispastics) ; 
but they are sometimes employed also externally as rubefacients, for 
the purpose of local or general stimulation in low forms of disease. 
Cantharides are preferred to all other substances as epispastics, and 
they are used for all the medicinal purposes that are within the 
range of this class of medicines. 

The following are the forms under which Spanish flies are used 
externally : — 

Ceratum cantharides (cantharides cerate), commonly known as 
blistering cerate, is made by mixing powdered cantharides (35 parts) 
with melted wax and resin (each 20 parts) and lard (25 parts). 
This is the preparation usually employed to raise a blister. It can 
be applied without the aid of heat, and should be spread on soft 
leather, or linen, or adhesive plaster, and covered with gauze or 
unsized paper. From four to twelve hours is the period for which 
the cerate should be applied; on the scalp a longer application 
may be required. For an ordinary impression, and where the 
cutaneous sensibility is not impaired by disease, it need not be kept 
on more than four or five hours. In cases of children less time is 
required for the application of the cerate, and great caution is neces- 
sary in applying it to infants. A poultice of bread and milk or 



* Taylor's Med. Jurisprudence, I, 1883, p. 350. 
f Ibidem. 



IRRITANTS— C A NTH A RIDES. 549 

flaxseed meal should be afterwards applied, which usually produces 
vesication if the action of the blister has not extended beyond rube- 
faction. If it be desirable to heal the blistered surface immediately, 
cotton-wadding or cerate may be placed over it, after the serum 
has been allowed to escape, the blebs being punctured at their most 
dependent points. To maintain the discharge the cuticle should be 
removed and basilicon ointment applied ; if the surface require fur- 
ther irritation, the ointments of savine, mezereon or cantharides may 
be used. The open or perpetual blister is, however, not required 
for ordinary antiphlogistic purposes; and indeed, as a general rule, 
the blistered surface should be allowed to heal as speedily as 
possible. In cases of excessive pain a poultice of bread-crumb and 
lead-water, with morphine sulphate gr. ^ mixed in it, or a starch- 
poultice or lime-liniment, is a soothing application. Goulard's cer- 
ate is an excellent application to heal obstinate ulcers from blisters. 
For the relief of strangury y diluents and diuretics are proper, as 
flaxseed tea, with sweet spirit of nitre, decoction of uva ursi, etc., 
and an opium or morphine suppository if the symptoms are severe. 
Blisters should not be applied directly over an inflamed part as they 
may increase capillary dilatation and the pain, where the skin is 
loose, over bony prominences, or to the mammary glands in preg- 
nancy. The danger of strangury should also be borne in mind. A 
thin piece of silver-paper, or camphor sprinkled on the blister is said 
to prevent t h i s effe ct. Ceratum extracti cantharidis (cerate of extract of 
cantharides) differs chiefly from the common cerate in being made 
with an alcoholic extract of the flies instead of the flies themselves; 
it is said to be more active than the former preparation. To prepare 
it, 30 parts of cantharides are to be percolated to exhaustion with 
stronger alcohol, evaporated to the consistence of a soft extract, and 
mixed with 15 parts of resin, 35 parts of yellow wax and 35 parts of 
lard (melted together). Ethereal, alcoholic, hydro-alcoholic and 
watery extracts of cantharides have been suggested as substitutes 
for the blistering cerate, and, mixed with wax and spread on thin 
cloth or paper, are termed vesicating taffetas. Linimentum canthar- 
idis {liniment of cantharides) consists of cantharides (15 per cent.) dis- 
solved in oil of turpentine; it is a prompt stimulating liniment, and 
may be applied to the skin to prepare it for the action of the blister- 
ing cerate. Collodium cum cantharide (collodion with cantharides) or 
cantharidal collodion, is made by percolating cantharides with 
commercial chloroform until the cantharides are exhausted, evapor- 



550 MATERIA MEDICA AND THERAPEUTICS. 

ating the liquid thus obtained and dissolving the residue in flexible 
collodion. It should be kept in a cool place. It furnishes a very 
convenient mode of blistering a small irregular surface, and is 
applied by means of a camel's-hair brush, in successive layers which 
should be covered with a piece of oiled silk. Applied to the glans 
penis it will prevent masturbation during the existence of the bleb. 
Charta cantharidis [cantharides paper) is made by boiling gently a 
mixture of 8 parts of white wax, 3 parts of spermaceti, 4 parts of 
olive-oil, 1 part of Canada turpentine and cantharides each, in 10 
parts of boiling water, and, after filtration, passing strips of paper 
over the surface of the mixture, which, when dry, are cut into rect- 
angular strips. The cantharidal preparations are used externally to 
promote the growth of the hair, in functional alopecia, and to destroy 
the tinea of ringzvorm. Dupuytreri s Pomatum is a tincture made 
with cantharides, 5j, and alcohol, fgj, incorporated with nine parts 
of lard. 

Cantharis Vittata (Potato-Flies) (not official). Several species 
of cantharis are found in the United States, and are good substitutes 
for C. vesicatoria. C. vittata, or the Potato-fly is most used. It 

FIG. 56. 




CANTHARIS VITTATA. 

resembles the Spanish fly in shape, but is rather smaller being 
about six lines in length, with black elytra or wing-cases, and in- 
habits chiefly the potato-plant. It contains cantharidin. 

AQUA AMMONI/E— WATER OF AMMONIA. 

Stronger Water of Ammonia {vide p. 221) may be used for the 
purpose of speedy vesication. It is more rapid, but much more 
painful than cantharides. Five parts of this, mixed with spirit of 
camphor, 2 parts, and spirit of rosemary, 1 part, has been used as a 
prompt vesicant, under the name of Granville's Lotion. A piece of 



IRRITANTS— ESCHAROTICS. 551 

flannel saturated with the liniment, is applied to the skin which it will 
generally blister in from three to ten minutes. Gondret's Vesicating 
Ointment is made by melting together 2 parts of expressed oil of 
almonds and 32 parts of lard, and adding to this mixture 17 parts of 
stronger water of ammonia; it will vesicate in ten minutes. Am- 
monia is applied locally as an antidote to the poison of venomous 
reptiles and insects. 

SUPPURANTS. 
OLEUM TIGLII— CROTON OIL. 

Croton Oil {vide p. 371), when rubbed on the skin, produces 
rubefaction, accompanied by a pustular eruption. It is used as an 
application to the throat and chest in subacute, or chronic laryngeal 
and bronchial affections, hoarseness and to rheumatic joints. It may 
be applied undiluted or mixed with one, two or three parts of olive- 
oil, or oil of turpentine, according to the susceptibility of the skin. 

LNGUENTUM ANTIMONII— ANTIMONIAL OINTMENT. 

This ointment consists of I part of antimonium and potassium 
tartrate mixed with 4 parts of lard. The peculiar eruptive effects of 
tartar emetic have been already noticed (see p. 250). It may be used 
in the form of ointment or solution in the same cases as croton-oil, 
but it is a more painful and permanent application. 

ESCHAROTICS. 

Escharotics (from ia/dpa, an eschar}, called also Cauterants, are 
medicines which destroy the structure and vitality of the parts to 
which they are applied. The eschar which their application pro- 
duces is followed by inflammation and suppuration of the surround- 
ing tissues, by which the slough is separated from the living parts. 

They are employed — 1. To effect the destruction of morbid 
growths, warts, condylomata, polypi, fungous granulations, etc. 

2. To destroy the virus of rabid and venomous animals, and of 
chancres and malignant pustules, and to prevent their absorption. 

3. For the cure of violent inflammation, by their substitutive action, 
as when they are applied to the mucous or cutaneous surfaces, in 
gonorrhceal ophthalmia, erysipelas, poisoned parts, carbuncles, etc. 

4. To stimulate indolent sinuses, ulcers, etc., where their influence 
is also of a substitutive character. 5. To form issues. 6. To 
remove morbid heterologous growths, as lupus, cancer, warts, etc. 



552 MATERIA MEDICA AND THERAPEUTICS. 

ARGENTI NITRAS FUSUS— FUSED SILVER NITRATE. 

Lunar Caustic (described at p. 208) is the most com- 
monly employed of the caustics. It has the advantage of not 
liquefying when applied, and its action is therefore confined to 
the parts with which it is brought in contact, and is superficial. 

Medicinal Uses. — It is used to remove fungous granu- 
lations in wounds and ulcers, to destroy warts, to alter the 
action of indolent ulcers, sinuses, and fistulcz, to subdue the 
inflammatory action of paronychia, erythema, etc., to arrest the 
progress of erysipelas and cancrum oris, to cut short variolous 
pustules, to cure skin-diseases by a substitutive action, and in 
inflammations of mucous membranes. In dilutions* of various 
strengths it is resorted to in every variety of inflammation of 
the mucous membranes; when a full impression is desired, a so- 
lution of gr. xx-xxx in distilled water f§j may be employed; for 
ordinary purposes, gr. ij to water fgj. The diluted silver nitrate 
{vide p. 208) is also used externally. 

POTASSA. ' 

Preparation and Description. — Caustic Potassa is prepared 
by the rapid evaporation of Solution of potassa (vide p. 473) with 
heat. While in the state of fusion, it is received into cylin- 
drical iron-moulds, and it occurs in the form of sticks of a 
brownish, grayish or bluish color, of a fibrous fracture, the 
odor of slaking lime, and a caustic urinous taste. It dissolves in 
alcohol and in less than its weight of water, and attracts both moist- 
ure and carbonic acid rapidly from the air. It is more or less im- 
pure as found in the shops. By digestion in alcohol it is freed from 
impurities insoluble in this menstruum (as the potassium carbon- 
ates), and it may be afterwards obtained quite white and pure by 
evaporation; it is then termed alcoholic potassa. The potassa of the 
shops is a hydrate, consisting of the elements of water and potassium. 

Effects and Uses. — It is the most powerful known escharotic, 
and differs from lunar caustic in extending its action to a consider- 
able depth beneath the surface to which it is applied. It acts by 
absorbing the water of a part and converting it into a slough. It is 
used chiefly to form issues, to destroy the virus of chancres and of ma- 
lignant pustules, and that from the bites of venomous reptiles and rabid 
animals, and sometimes also to arrest the sloughing of carbuncles, 
and ; from its deep-reaching action, it is preferred to lunar caustic in 



IRRITANTS— CHROMIC ACID. 553 

these cases; applied to the cutaneous surface, in cases of threatened 
abscess, carbuncle, etc., it will sometimes avert the progress of the in- 
flammation. It is a good application in cases of rodent ulcer, the 
superficial forms of epithelioma generally, and in lupus, the diseased 
tissue having been removed with a knife as thoroughly as possible 
previous to the application of the caustic. When it is applied to 
the skin, this should be covered with linen spread with adhesive 
plaster, having a hole the size of the spot to be cauterized. A solu- 
tion (5jss to fgij of water) is used as a rtcbefacient. 

Potassa cum Calce {Potassa with Lime) is prepared by rubbing 
up equal parts of potassa and lime. It is a grayish-white powder, 
which is sometimes made into a paste with a little alcohol, and is 
termed Vienna Paste ; it has been also formed into sticks. The 
presence of lime renders this a milder, less deliquescent and more 
manageable caustic than potassa ; it is a favorite application to chan- 
cres, ncevi, and rodent ulcer. 

SODA. 

Caustic Soda is prepared by the rapid evaporation of Solution of 
soda {vide p. 476) until ebullition ceases and the soda melts ; when 
it has congealed, it is broken into grayish-white, opaque, brittle 
fragments, which are very corrosive, very soluble in water, soluble 
in alcohol, and deliquescent, though, unlike potassa, it does not be- 
come permanently liquid, but after a time effloresces. 

Effects and Uses. — It is employed for the same cauterant 
purposes as potassa, than which it is somewhat milder in action, 
London Paste is made by rubbing equal parts of soda and lime. 

ACIDUM CHROMICUM- CHROMIC ACID. 

Preparation and Description. — Chromic Acid (Cr0 3 ) is 
obtained by the reaction of sulphuric acid upon a solution of potas- 
sium bichromate. It is properly chromic anhydride, and occurs in 
the form of anhydrous, deep-red, needleform crystals, of an acid, 
metallic taste; they are deliquescent and very soluble in water, with 
which they form an orange-yellow solution. 

Incompatibles. — Chromic acid is incompatible with organic 
matter; it must not be mixed with glycerin, alcohol, etc., as de- 
composition and explosion may ensue. 

Effects and Uses. — Thts is an escharotic of great power, 
decomposing the tissues by its rapid oxidizing action and staining 
them blackish-brown. Used in the form of paste, or solution 



554 MATERIA MEDIC A AND THERAPEUTICS. 

more or less diluted, it is a most efficacious application to lupus, 
morbid growths and excrescences, as syphilitic condylomata, etc., and 
is unequalled as an agent for removing warts from the hands. It 
gives less pain than other caustics ; but it is to be used with cau- 
tion, especially near delicate parts like the eye, as its action is deeply 
penetrating. The solution may be made of the strength of from gr. 
100-5J to fgj of water ; and is to be applied by means of a pencil or 
glass-rod. A 5 per cent, solution of chromic acid will check the fetor 
of sweating of the feet, but the skin must not be broken. 

ACIDUM ARSENIOSUM-ARSENIOUS ACID. 

This is a powerful escharotic {vide p. 457), and is occasionally 
applied in lupus, onychia maligna, cancerous ulcers, and to change the 
action of indolent sinuses ; but its use is attended with danger. When 
used, it should be applied freely, as a large amount causes such 
rapid death of the tissues that absorption is rendered impossible. 
It may be diluted with one or more parts of sulphur. 

BROMUM— BROMINE. 

Preparation, Description and' Tests. — Bromine (Br) is an 
elementary body, bearing close chemical affinities to iodine. It 
is a constituent of sea-water and of many mineral springs. In 
Europe it is obtained principally from the mother liquors of the 
salt mines of Stassfurt, in Germany; in this country, from saline 
springs in western Pennsylvania, Ohio, and West Virginia, in 
which it exists as magnesian bromide. It is a volatile, dark-red 
liquid (sp. gr. 3), of a caustic taste and a strong, disagreeable 
smell, sparingly soluble in water, more soluble in alcohol, and still 
more so in ether. 

Tests. — With starch-paste it yields a yellow color ; with silver 
nitrate, a yellowish-white precipitate. 

Physiological Effects. — The action of bromine on the system 
considered chemically is very similar to that of chlorine. It de- 
composes hydrogen compounds, forming hydrobromic acid, and 
separating the elements combined with the hydrogen; hence it is a 
deodorant and disinfectant. On account of these properties, and 
because it is a liquid, it is a severe, rapid and thorough caustic. The 
vapor is intensely irritant to the mucous membrane, causing, when 
inhaled in sufficient quantity, laryngitis, bronchitis, and pneumonia. 

Toxicology. — In the stomach it is a corrosive poison. Snell * 

%N. Y. lourn. of Med., 1850, p. 179. 



IRRITANTS— MINERAL ACIDS. 555 

reports a case in which 5j killed an adult in seven hours. The 
symptoms were immediate dyspnoea, epigastric pain, trembling of 
the hands and great anxiety. 

Medicinal Uses. — In acute and chronic nasal catarrh, ozcena, 
and hay-asthma, a small quantity of a solution (5ss) in alcohol (fSjv) 
may be inhaled from a wide-mouthed vial with good result. 

Locally, in Jwspital gangrene, after removing the slough, it is 
one of the best escharotics. It is also used as a caustic in chancre, 
phagedena, and various forms of cancer, especially cancer of the 
uterus. It is never employed internally. 

ZINCI CHLORIDUM— ZINC CHLORIDE. 

This is also a powerful escharotic (vide p. 205); and, in addi- 
tion to its corrosive properties, it appears to exercise a greater in- 
fluence over the vital action of neighboring parts than some other 
caustics. The separation of its eschar leaves very healthy and vig- 
orous granulations, and it is one of the best applications that can be 
made to intractable, indolent ulcers and sinuses. It will sometimes 
cure lupus. 

LIQUOR HYDRARGYRI NITRATIS— SOLUTION OF MERCURIC NITRATE. 

This preparation (vide p. 443,) termed also the acid nitrate of 
mercury, is a valuable caustic application to malignant ulcers, hos- 
pital gangrene, chancre, etc. 

HYDRARGYRI CHLORIDUM CORROSIVUM -CORROSIVE CHLORIDE OF MERCURY. 

Corrosive Sublimate is more frequently used as a stimulant or 
antiseptic wash than as a caustic (see p. 438). 

POTASSII BICHROMlS-POTASSIUM BICHROMATE. 

This salt, already noticed under the head of Alteratives (vide 
index), is a good caustic application, in saturated solution or in 
powder, to syphilitic and other vegetations. 

ACIDA MINERALIA— MINERAL ACIDS. 

The mineral acids (vide p. 176) are powerful escharotics, but 
are inconvenient for many uses, on account of the extension of their 
action beyond the point of application. On the other hand they 
can be made to reach the bottom of sinuses and fistulcz, which are 
inaccessible to the solid caustics. Nitric acid, for such purposes, 
has no equal in the list of escharotics; it is used also to destroy 



556 MATERIA MEDICA AND THERAPEUTICS. 

warts. It stains the tissues yellow. Properly diluted, the mineral 
acids are employed in injections, gargles, etc.; and in the form of 
ointment, in skin-diseases. 

Copper Sulphate (vide p. 202) and Alum (vide p. 21 1) are 
mild escharotics, but are used chiefly to remove fungous granula- 
tions in ulcers, as a mild cauterant to granulations in ophthalmia, 
to mucous patches, etc. The actual cautery and moxa have been 
alluded to under the head of Heat (vide p. 41). 

Under " Irritants" maybe considered sapo viridis and chrysa- 
robin, two remedies which, although not used as escharotics, are 
applied to the skin in certain of its diseases for their local irritant 
effect. The former has decided caustic properties, due to the 
potassa which it contains. 

Sapo Viridis — Green Soap — is a soft, greenish, jelly-like soap, 
prepared from potassa and the fixed oils, very soluble in water 
and alcohol. Like all soaps, especially soft soaps, it is a mild caus- 
tic, and was introduced into medical practice by Professor von 
Hebra, in the treatment of various cutaneous affections, especially 
of the scaly variety. 

Medicinal Uses. — It is useful to remove the infiltrated patches 
of the various forms of chronic eczema, and for this purpose should 
be well rubbed in with a piece of flannel until all traces of the soap 
have disappeared, when the flannel is wet with water and the rub- 
bing again performed; the surface should be then washed with clean 
water and carefully dried, when it will be found red and angry- 
looking, with here and there a minute point from which serum is 
oozing. Between the applications ointments are to be applied. 
Sapo viridis is also much used to get rid of scales and crusts, as in 
psoriasis, phthiriasis, and in various other skin-affections. As a 
local stimulant in alopecia, the following makes a serviceable lotion, 
saponis viridis, oij, alcohol, §j, M.S. Dissolve with heat and filter; 
apply as a shampoo. Green soap is also applicable to the removal 
of freckles, to cleanse the toes of sebaceous matter in fetor of the feet, 
and to prevent further friction about chafed parts. In tinea versi- 
color it will often effect a prompt cure, and it is highly useful to 
cleanse the skin in parasitic affections, as tinea circinata before the 
application of a germicide. 



IRRITANTS— CUR YSAR OBINUM. 557 

Tinctura saponis viridis {tincture of green soap) consists of 65 
per cent, of green soap and 2 per cent, of oil of lavender dissolved 
in alcohol. It is milder in its action than green soap, and is used 
to fulfil the same indications. 

Chrysarobinum — Chrysarobin, often improperly called Chry- 
sophanic Acid — consists of a mixture of principles extracted from 
araroba or goa-powder, a substance found in the clefts of Andira 
araroba {Nat. Ord. Leguminosas). It has also been obtained from 
different species of rhubarb. It is an orange-yellow powder, crys- 
tallizing in needles, insoluble in water, only slightly soluble in alco- 
hol and chloroform, readily so in ether, and possesses neither taste 
nor smell. 

Physiological Effects. — When applied locally, it is an irri- 
tant to the skin, staining it yellow, and causing, in excess, irritation 
and [ inflammation, accompanied by swelling, itching, pain, heat, 
and sometimes a papular eruption, especially when in contact with 
the skin about the head and face. The action is not always limited 
to the part to which* it is applied, but extends to the healthy skin in 
the vicinity. Observers do not agree respecting the internal effects 
of this drug. 

Medicinal Uses.— It is principally used as an external applica- 
tion in cases of skin-disease due to vegetable parasites zsfavus, the 
different forms of tinea, etc., for which it is an excellent remedy, 
and in psoriasis, in which disease the scabs soon disappear and the 
patches become white under its use. In the treatment of ringworm 
the parts should first be cleansed with sapo viridis in order to facili- 
tate contact of the remedy with the parasite, and then the following 
solution should be applied: ^ Chrysarobini, gr. v-x ; chloroform^ 
f§j. M. S.— Shake before using. After this is dry, liquor gutta- 
percha^ may be painted on as a protective. The solution of 
chrysarobin should be applied every few days until the parasite is 
effectually destroyed. Alexander * reports excellent results in sixty 
cases of ringworm of the scalp from the use of a 10 per cent, solution 
of chrysarobin in gutta-percha solution. It must not be forgotten 
that chrysarobin produces a permanent stain upon clothing. It 
should be applied to the head or face with caution on account of 
the liability to swelling and oedema of the eyelids. It is never 

-■• Journ. of Cutaneous and Venereal Diseases, 1885, p. 33. 



558 MATERIA MEDIC A AND THERAPEUTICS. 

used internally. The ointment (made by rubbing 10 parts of chry- 
sarobin with 90 parts of benzoinated lard) may be used. 

ORDER III— DEMULCENTS. 

Demulcents, or Lenitives, are medicines which soften and relax 
the tissues, and when applied to irritated or inflamed surfaces, di- 
minish heat, tension, and pain. They consist chiefly of gum or 
mucilage, or a mixture of these with saccharine and farinaceous 
substances, and form with water viscid solutions. Their constitu- 
tional effects are principally nutritive, though perhaps, to some 
extent, they relieve irritation in distant organs by modifying the 
acridity of the secretions. Demulcent solutions are. administered 
internally — I. To sheathe and protect the gastro-enteric surface 
from the injurious effects of irritating substances, particularly acrid 
poisons. 2. To relieve irritation and inflammation of the alimen- 
tary canal, as in gastritis, enteritis, diarrhoea, and dysentery ; and 
for this purpose they may be administered by either the mouth or 
rectum. 3. In catarrhal affections, in which they are probably use- 
ful in part by the transmission of their lubricating and soothing 
effects on the fauces and oesophagus by reflex action to the laryn- 
geal and bronchial membranes, and in part by modifying the acridity 
of the expectorated matters. 4. In affections of the urinary pass- 
ages, as strangury, cystitis, etc., and in these cases they act chiefly 
by diminishing the acridity of the secretions. 5. As agreeable 
drinks, to quench thirst and promote the action of the secreting 
and exhaling organs in febrile affections. Their effects in these 
cases are owing partly to the water which they contain, to which 
they are added merely for the sake of flavor, and partly also to the 
nutriment which they furnish. When administered with the object 
of increasing the proportion of the fluid parts of the blood, demulcents 
are termed Diluents. 6. As light diet for the sick. 7. For phar- 
maceutical purposes, to suspend substances insoluble in water, etc. 

Externally, mucilaginous solutions are employed extensively 
to relieve the heat, swelling and pain of inflammation, wounds, 
burns, etc.; to hasten suppuration where inflammation is too far ad- 
vanced for resolution ; to cleanse foul and scabby ulcers ; to promote 
suppuration from granulating surfaces, etc., etc. ' When applied 
externally, this class of medicines is termed emollients. Mucilagin- 
ous and amylaceous substances are applied to inflamed and ulcer- 
ated parts, mixed with water so as to form soft masses, termed — 



DEMULCENTS. 559 

Cataplasms or Poultices, which are useful vehicles for the 
application of heat and moisture. (F 'or flaxseed poultice see p. 565). 
When applied to a healthy part a poultice acts as a sedative and 
relaxant. In the early stages of inflammation it lessens the amount 
of blood at the seat of morbid action, by dilating the cutaneous 
vessels, and prevents stasis and the migration of the white corpus- 
cles ; after stasis has taken place and migration has commenced, it 
favors the formation of pus, probably by aiding migration through 
the relaxing effect it exerts on the walls of the vessels, and also by 
promoting cell-proliferation : applied to a wound, it stimulates the 
formation of embryonic and granulation-tissue, from its influence 
over cell-proliferation. If the use of poultices be too long persisted 
in, the part becomes pale, sodden, relaxed and shrivelled and even 
devitalized, in extreme cases. 

Poultices are used in the early stages of acute inflammation of 
internal viscera for their antiphlogistic effects : thus the abdomen may 
be covered with a large poultice in the early stages of peritonitis, if 
not objectionable on account of its weight, and a jacket-poultice may 
be used with excellent effect in the early stages of acute bronchitis, 
pneumonia or pleuritis, the chest being completely surrounded by 
the poultice. They are sometimes used for the same purposes in 
external inflammations. For their effects on pus-formation and 
cell-proliferation, and as they soften the skin, relax the cuticle thus 
lessening tension and pain, they are useful in external inflammation 
when suppuration can no longer be prevented, as in boils, carbuncles, 
abscess, felon, etc., and they are also applied to granulating surfaces, 
as in wounds or ulcers. As they stimulate the granulation-process, 
their application should be discontinued as soon as the granulations 
reach the level of the surrounding skin. During the day poultices, 
should be changed every three hours ; at night, every four hours. 

When applied to a granulating surface, or indeed, to an open 
wound of any kind, the poultice should be thoroughly antisepticised, 
as by admixture with a solution of corrosive sublimate, else it forms 
an excellent nidus for the development of various forms of proto- 
phytes, the multiplication of which will be accelerated by the heat 
and moisture. 

In the treatment of gangrenous, sloughing or foul-smelling 
ulcers or wounds, yeast or charcoal is often added to the poultice, to 
aid in the separation of the slough or to correct the fetor. The 
charcoal-poultice contains wood-charcoal §^, bread-crumb Sij, lin- 



560 MATERIA MEDICA AND THERAPEUTICS. 

seed-meal Sj^, boiling water, fgx. M., adding the meal gradu- 
ally. The yeast-poultice consists of beer-yeast f^vj, wheat-flour 
Sxjv, water at ioo° F., fgvj. Mix the yeast with the water 
and stir in the flour. Poultices may be medicated with lead- 
water and laudanum, or other substances, if it is desired to abate 
the inflammatory process. The laudanum-poultice is an efficient 
anodyne in synovitis. For the rubefacient-poultice see index. 

AQUA— WATER. 

Water has important medicinal as well as pharmaceutical uses. 
The Pharmacopoeia directs it to be employed in the purest attainable 
state, which is rain or snow-water; for pharmaceutical purposes, 
distilled water {aqua destillatd) should be used. Pure water is a 
transparent liquid without color, taste or smell; but owing to its ex- 
tensive solvent powers, in the natural state it is more or less con- 
taminated with foreign matters. It is a compound by volume of 2 
atoms of hydrogen and I of oxygen (H 2 0). 

Effects and Uses. — Water is necessary for the solution and 
digestion of our food; in either insufficient or excessive amount it 
may prove injurious. Thus, without a proper supply of water, not 
only the absorption of soluble matters in the stomach is interfered 
with, but also the passage of undigested substances into the intes- 
tines; and in the absence of water, some articles, as sugar, do not 
undergo the fermentation necessary for digestion. On the other 
hand, an excess of water taken into the stomach impairs digestion 
by over-dilution of the gastric juice, and will occasion the acetous 
fermentation of saccharine articles. Water is eliminated from the 
system by the intestines, skin and lungs, but chiefly by the kidneys; 
and it is believed, in large amounts, to increase not only the water, 
but the solid constituents, of the urine; hence its use as a diuretic. It 
materially augments the perspiration particularly when taken warm, 
and is consequently of great value as a diaphoretic. As it promotes 
both the metamorphosis and construction of tissue, it may produce 
a valuable alterative effect in morbid taints of the system, and prove 
a useful adjunct to more active eliminative agents. Water is the 
basis of all drinks administered to relieve the thirst of fever and 
moderate the undue viscidity of the blood which is present in 
inflammation; it must not be permittted in excess, however, as un- 
due amounts may produce nausea, flatulence and even vomiting and 
diarrhoea. Ice-water is best adapted to febrile conditions, sipped 



DEMUL CENTS— A CA CIA. 561 

often and in small quantities. When drunk inordinately at meals, 
a custom prevalent in the United States, it acts not only injuriously 
upon digestion for the moment, but also superinduces a condition 
known as ice-water dyspepsia. To allay the thirst that follows a 
profuse perspiration brought on by exercise in warm weather, the 
fauces should be rinsed before drinking and the fluid then slowly 
swallowed in small quantities. In constipation a tumblerful of water 
taken before breakfast will commonly bring about an evacuation of 
the bowels. The uses of water, as an external agent, have been no- 
ticed under the head of heat an.d cold. 

Carbonic Acid Water (H 2 C0 3 ) (not official). Water impregnated 
with a quantity of carbonic acid equal to five times the bulk of the 
water (which may be obtained from sodium bicarbonate or from 
marble, by means of diluted sulphuric acid) often proves useful in 
allaying nausea and vomiting, and is also a good vehicle for some 
of the neutral purgative salts which are of unpleasant taste. M. 
Jacquemaire* has called attention to the value of carbonic acid 
water, under a pressure of four or five atmospheres, to sterilize 
aqueous solutions of the salines, the pyrophosphate of iron and 
pepsin. 

Carbonic acid may be taken in the form of natural mineral 
waters, as Apollinaris, Clysmic, Giesshubler and Summit Soda 
Sprmgs of California. . These are particularly agreeable in cases of 
fever, and to relieve nausea and vomiting. Being alkaline they are 
adapted to prolonged use in the uric acid diathesis, particularly the 
Clysmic water. Mixed with milk they are well suited to acid 
dyspepsia. 

ACACIA. 

Acacia, or Gum arabic, is a gummy exudation derived from 
Acacia Verek and other species of Acacia {Nat. Ord. Leguminosae), 
thorny or prickly trees or shrubs of Africa and Arabia. Consid- 
erable gumf is collected by the Somali tribe on the N. E. coast of 
Africa, who obtain it by incision. 

Preparation and Varieties. — The gum exudes either through 
natural cracks in the bark or through incisions made to facilitate its 
exudation, and hardens on exposure. Several commercial varieties 
are known, as Turkey, Barbary, Senegal, India, etc., of which the 
most important are Turkey gum and Senegal gum. I. Turkey gum 

* Bull. Gen. de Therap., Aout isieme, 1888. 
\ Journ. of Pharmacy, XII, 226. J. Vaughan. 

36 



562 MATERIA MEDICA AND THERAPEUTICS. 

(Kordofan gum) is the kind usually found in the shops. It consists 
chiefly of small, irregular fragments, interspersed with larger pieces 
of a whitish color, which is sometimes slightly tinged with yellow 
or reddish-yellow. It is purer than other varieties, and is generally 
characterized by innumerable minute fissures pervading its sub- 
stance. 2. Senegal gum occurs in roundish or oval unbroken 
pieces, sometimes whitish, but generally yellowish, reddish or 
brownish-red. 3. Barbary gum comes from Morocco, and consists 
of two kinds, one resembling the Turkey, the other the Senegal 
gum. 4. India gum, though brought from India, is collected on the 
northeastern coast of Africa, the Somali district, and in the ports of 
the Red Sea. It is in pieces of varying size, color and quality, and 
is often contaminated with Bassora gum, which is insoluble in 
water. All the varieties are more or less transparent, hard, brittle 
and pulverizable, and form a white powder. They are inodorous, 
with a feeble, slightly sweetish taste, and when pure dissolve wholly 
in the mouth. When kept in a dry place they undergo no change 
by time. 

Chemical Constituents. — Acacia consists almost wholly of 
a peculiar proximate principle, usually termed Gum, but latterly 
designated as Arabin. It is soluble in hot or cold water forming a 
viscid solution called mucilage, and is insoluble in alcohol, ether 
and the oils. Its aqueous solution is acid. Arabin (gummic or 
arable acid) (C 12 H 22 O n ) is combined with about 3 per cent, of lime, 
forming a soluble salt, calcium gummate. Gums of inferior trans- 
parency and solubility contain bassorin, an inert principle, insoluble 
in water and alcohol. 

Incompatibles. — Alcohol precipitates gum from its aqueous 
solution ; lead acetate (which is also a delicate test), lead nitrate, 
solution of the ferric salts and borax in concentration render its 
solution turbid and jelly-like. 

Aids. — Mucilage of tragacanth, slippery elm, and sassafras pith. 

Effects and Uses. — Acacia is extensively employed, intern- 
ally, as a demulcent in gastro-enteric inflammation, as gastritis, en- 
teritis, diarrhoea, dysentery, cases of acrid poisoning, etc. ; as a lubri- 
cant to the fauces in catarrhal affections, pharyngitis for example ; 
and also as a vehicle for anodynes and expectorants in cough mix- 
tures ; and as a diluent in fevers and inflammatory cases. It is not 
now considered to be digestible, and can scarcely rank (as formerly 
supposed) with nutrients. 



DEMUL CENTS— TRA GA CANT//. 563 

Administration. — It is usually administered in solution (5j to 
boiling water Oj, to be given when cool); in cases of irritation of 
the fauces it may be taken into the mouth and allowed slowly to 
dissolve. For pharmaceutical purposes acacia is much used to 
suspend insoluble substances in water, and in making pills and 
lozenges. Mucilago acacice [mucilage of acacia) is used in mak- 
ing pills, emulsions, etc.; it becomes sour by keeping. Syrupus 
acacice {syrup of acacia) (25 percent, of mucilage of acacia mixed 
with 75 per cent, of syrup,) is used for the same purpose. Mistura 
amygdala? {almond mixture) is made by dissolving a mixture of 6 
parts of blanched sweet almonds, 1 part of acacia, and 3 parts of 
sugar, in 100 parts of distilled water ; it is a pleasant demulcent 
and vehicle for other medicines. By dissolving equal parts of 
sugar and acacia in water and evaporating, an agreeable demulcent 
is obtained, known as gum-pectoral, which is sold as an imitation of 
jujube paste. 

TRAGACANTHA-TRAGACANTH. ' 

This is a gummy exudation derived from the Astragalus 
gummifer and other species of astralagus (Nat. Ord. Leguminosae), 
small shrubs found in Persia, Asia Minor and countries bordering 
on the Levant, with numerous branches covered with imbricated 
scales and beset with spines. 

Preparation and. Constituents. — Tragacanth exudes spon- 
taneously in the hot weather, and hardens, as it exudes, in forms of 
various shapes. It occurs in irregular tortuous flakes or filaments, 
of a whitish or yellowish-white, or occasionally a slightly reddish 
color, somewhat translucent, resembling horn in appearance. It is 
hard and fragile, but very difficult of pulverization, and has no smell 
and very little taste. When heated with water it swells and forms 
a paste, and if agitated with an additional quantity it forms a uniform 
mixture, from which it is, however, almost entirely deposited upon 
standing a day or two. It contains two constituents, one soluble 
in water resembling arabin, but not identical with it, combined with 
calcium, the other termed tragacanthin (C 12 H 20 O 10 ). 

Effects and Uses. — Tragacanth is seldom given internally , 
on account of its difficult solubility. It is useful in suspending 
heavy insoluble powders, and answers better than gum arabic to 
impart consistency to lozenges. 

Administration. — Mucilago tragacanthce {mucilage of trag- 
acanth) — tragacanth 6 parts, with glycerin 18 parts, in water 



564 MATERIA MEDICA AND THERAPEUTICS. 

enough to make the whole weight ioo parts, is used in making pills 
and troches, and for the suspension of heavy insoluble metallic 
substances. 

LINUM— FLAXSEED. 

This is the seed of Linum usitatissimum, or Common Flax 
(Nat. Ord. Linaceae), an annual plant of the height of two feet, orig- 
inally a native of eastern countries, but naturalized in Europe, and 
cultivated in all parts of the world The seed and oil are both 
official. The seeds are about a line in length, oval, smooth and 
glossy, of a brown color externally and yellowish-within ; a variety 
of flax is cultivated in Ohio, the seeds of which are a greenish-yel- 
low. Flaxseeds are inodorous, and have an oily, mucilaginous 
taste. 

Chemical Constituents. — They contain 30 or 35 per cent, of 
fixed oil, a large proportion of mucilaginous matter, vegetable albu- 
men, etc. ; the mucilaginous matter, which is found chiefly in the 
husks of the seeds, consists, about one half, of a principle soluble 
in cold water, resembling arabin, and about one-third of a principle 
insoluble in water. The oil {oleum lini or linseed- oil) is obtained by 
expression from the interior part of the seeds ; it is laxative in the 

Fig. 57. 




LINUM USITATISSIMUM. 



dose of foj-ij, but it is chiefly applied externally, mixed with an 
equal amount of lime-water, as in the old "carron oil," to burns. 



DEMULCENTS— SLIPPERY-ELM BARK. 565 

Effects and Uses. — Decoction is an improper mode of pre- 
paring a demulcent solution of flaxseed, as boiling extracts part of 
the oil ; but it answers very well when it is used as a laxative enema. 
Ground flaxseed forms a much used emollient poultice {vide p. 559), 
which is prepared by gradually adding boiling water to flaxseed 
meal in a vessel previously heated, and constantly stirring until it 
makes a smooth dough of proper consistence, which is then spread 
on muslin and a piece of gauze or mosquito-netting placed upon it, 
to prevent it from adhering to the skin. After the poultice is ap- 
plied, it should be covered with oiled silk or waxed paper, to retain 
the heat and prevent evaporation. The cake remaining after the 
expression of the oil, retains the mucilaginous and albuminous con- 
stituents of the seed, and forms a food for cattle, under the name of 
oil-cake. This is used for making poultices, but it is inferior to 
the meal made from the seeds which have not been deprived of 
their oil. 

OLEUM GOSSYPII SEM1NIS— COTTON-SEED OIL. 

This is a fixed oil expressed from the seed of Gossypium 
herbaceum {vide p. 275) and other species of Gossypium. It is 
subsequently purified by being bleached with alkalies and with sul- 
phuric acid, and is finally obtained as a clear, pale-yellow, oily 
liquid, without odor and having a bland, nut-like taste. It contains 
olein and palmitin. It is very bland, and may be used as a substi- 
tute for almond or olive-oil. It is used externally as an ingredient 
of linimentum amnionic? [vide index), linimentinn calcis (p. 483), 
linimentum camphorce [vide p. 126), and linimentum plumbi sub ace- 
tatis {vide p. 200). 

ULMUS— SLIPPERY-ELM BARK. 

This is the inner bark of Ulmus fulva, or Slippery-Elm {Nat. 
Ord. Urticaceae), a lofty indigenous tree which is found throughout 
the United States north of Carolina, and grows most abundantly 
west of the Allegheny Mountains. 

Description and Constituents. — The inner bark is prepared 
for use by the removal of the epidermis ; it is found in the shops 
in long flat pieces, of fibrous texture, tawny on the outer surface 
and reddish on the inner, of a peculiar but not unpleasant smell 
and a very mucilaginous taste. It affords a light grayish, fawn- 
colored powder. A large quantity of mucilaginous matter is con- 
tained in it, which is yielded readily to water, also some tannic 
acid. Much of the bark lately brought into the market is inferior, 



566 MATERIA MEDICA AND THERAPEUTICS. 

containing but little mucilage; it is less fibrous and more brittle 
than the genuine bark. 

Effects and Uses. — Slippery-elm bark is a valuable demulcent, 
extensively and advantageously employed in acute dysentery, diar- 
rhoea, genito-urinary diseases, catarrhs, etc. It is also highly 
nutritious. Externally it is an excellent emollient application, in 
the form either of infusion or of poultice made with the powder. 
It has been also made into a spongy mass, as a tent to dilate the os 
uteri, as in dysmenorrhcea. 

Administration. — The infusion — mucilago ulmi {mucilage of 
slippery-elm bark) (2 parts to water 100 parts)— may be used ad 
libitum. 

SASSAFRAS MEDULLA— SASSAFRAS PITH. 

Sassafras pith is the pith of the stems of Sassafras officinale 
{vide p. 384). It occurs in light, spongy, whitish, slender, cylindri- 
cal pieces, of a mucilaginous taste. It abounds in a gummy mat- 
ter, which it yields readily to water, forming a limpid, viscid mucil- 
age. This mucilage (2 parts to water 100 parts) — is a pleasant 
demulcent drink in dyspeptic, nephritic, and catarrhal affections, and 
is much used as a soothing application in ophthalmia. 

althaea. 

The root of Althaea officinalis {Nat. Ord. Malvaceae), com- 
monly known as Marshmallow, an herbaceous European plant, 
occasionally found, too, on the borders of salt marshes in our own 
country, with ovate, soft, velvety, crenate leaves and pretty flesh- 
colored flowers, is much used in Europe as a demulcent. The 
roots of other Malvaceae are often substituted for those of the offi- 
cial roots. 

Description and Constituents. — The roots are imported in 
pieces, three or four inches in length, of nearly the thickness of the 
finger, light, easily broken, white externally, of a peculiar faint smell 
and a mild, mucilaginous, sweetish taste. The chief constituents of 
marshmallow are mucilage and starch, the former soluble in cold 
water, the latter requiring boiling water. It contains also asparagin 
(C 4 H 8 N 2 3 .H 2 0), a crystalline principle found in asparagus-shoots 
and other plants. 

Effects and Uses. — Marshmallow decoction is employed as a 
demulcent in inflammatory and irritated conditions of the mucous 
membranes of the respiratory, digestive and urinary organs, and 



DEMLL CENTS— GL YC YRRHIZA . 567 

poultices made of the bruised or powdered root are used externally. 
The syrup is official. 

OLEUM SESAMI— OIL OF BENNE. 

This is a fixed oil expressed from the seed of Sesamum in- 
dicum (Nat. Ord. Pedaliaceae), an annual plant, growing to the 
height of four or five feet, with ovate-lanceolate, lobed leaves, red- 
dish-white axillary flowers, and an oblong capsule containing small 
oval yellowish seeds. It is a native of India, but is now raised 
throughout Asia and in Egypt and Italy, also in South Carolina and 
in the neighborhood of Philadelphia. The seed contains a fixed 
oil, and the leaves yield to cold water a large quantity of mucilage 
resembling that of sassafras-pith. 

Effects and Uses. — This is a highly-esteemed demulcent 
drink, used in cholera infantum and infantile bowel complaints. The 
seeds are eaten as food by the negroes in Carolina, in broths, pud- 
dings, etc. The oil, which is inodorous, of a bland, sweetish taste, 
and keeps well may be used internally or externally as a substitute 
for olive-oil. 

CYDONIUM. 

This is the seed of Cydonia vulgaris or Quince-tree (Nat. Ord. 
Rosaceae), a native of Europe, but cultivated in the United States 
for the fruit. The seeds are ovate, angular, reddish-brown exter- 
nally, white within, inodorous, insipid, and abound in mucilage. 

Effects and Uses. — They are used, principally, externally, in 
solution (mucilago cydoitii), two parts to water 100 parts; but may 
be given internally as a demulcent, in g astro-intestinal or bronchial 
inflammations. 

GLYCYRRHIZA. 

Glycyrrhiza or Liquorice Root is the root of Glycyrrhiza 
glabra (Nat. Ord. Leguminosae), a small herbaceous perennial plant, 
of the countries around the Mediterranean. It is imported from 
Sicily and Spain; and a portion of the Sicilian root is said to be the 
product of G. echinata. 

Description and Constituents. — As found in the shops gly^ 
cyrrhiza is in long wrinkled pieces, often worm-eaten, varying from 
a few lines to more than an inch in thickness, externally grayish- 
brown, internally yellowish, without smell, and of a sweet, mucila- 
ginous, sometimes slightly acrid taste. The best pieces are of 
the brightest yellow internally. The powder is grayish-yellow, 



568 MATERIA MEDICA AND THERAPEUTICS. 

or, if it be powdered with the epidermis removed, pale sulphur-yel- 
low. The Russian glycyrrhiza of commerce is said to be derived 
chiefly from G. glandulifera; the root has a reddish tint and a scurfy 
surface, which distinguish it from the smoother one, G. glabra. The 
constituents of glycyrrhiza are a peculiar transparent yellow, un- 
crystallizable sugar, termed glycyrrhizin, (C 16 H 24 6 ) (which is 
scarcely soluble in cold water, but soluble in boiling water and alco- 
hol, and is a glucoside, splitting up, when warmed with a dilute 
acid or upon being boiled, into glycyrretin and sugar), starch, as- 
paragin, an acrid resin, etc. 

Effects and Uses. — Liquorice root has a sweetish agreeable 
taste and when chewed increases the flow of saliva. A decoction of 

Fig. 58. 




GLYCYRRHIZA GLABRA, ROOT. 



glycyrrhiza is a useful demulcent in dysenteric, catarrhal and ne- 
phritic affections ; it is also added to decoctions of acrid substances, 
to cover their taste and acridity. A bit of the extract dissolved in 
the mouth will allay hoarseness and pharyngeal cough. It should be 
made of the root deprived of its cortical part, which is acrid and 
without demulcent virtues; by long boiling the acrid resin is ex- 
tracted. The powder is used in making pills. 

Administration. — A fluid extract is official, and is a useful ad- 
dendum to cough-mixtures and to disguise the taste of ammonium 
carbonate or chloride. 

Glycyrrhizinum Ammoniatum [Ammoniated Glycyrrhizin) is pre- 
pared by macerating and then percolating glycyrrhiza with water of 
ammonia, precipitating with sulphuric acid, washing the precipitate 



DEMUL CENTS- L YCOPODIUM. 569 

and dissolving in water of ammonia and spreading on glass-plates 
to dry. It may be used for the same purpose as the other prepara- 
tions of liquorice. 

Extractum Glycyrrhizee {Extract of Glycyrrhiza — Extract of 
Liquorice). 

Preparation and Description. — This is made by the evapo- 
ration of a decoction of the half-dried root. It comes to this 
country chiefly from Leghorn and Messina, and in part, also, 
from Spain ; a good extract is prepared, too, in New York and 
England. The crude extract, when good, occurs in black, flat- 
tened, cylindrical rolls, about an inch in diameter, which are 
dry, brittle, with a shining fracture, of a very sweet, peculiar, 
slightly acrid taste, and are quite soluble in water. It is, how- 
ever, much sophisticated, and for internal use is generally refined 
by dissolving the impure extract in water and water of ammonia, 
without ebullition, straining the solution and evaporating ; sugar is 
often mixed with it, and sometimes mucilage or glue. Refined 
liquorice {extractum glycyrrhizee punmi) is in small cylindrical pieces, 
not thicker than a pipe-stem. 

Effects and Uses. — Liquorice-extract is chiefly employed for 
pharmaceutical purposes. It is, however, a pleasant demulcent, 
much used as an addition to cough-mixtures and lozenges and to dis- 
guise the taste of acrid infusions, decoctions, turpentine, hyoscya- 
mus, quinine, etc. 

Administration. — Mistura glycyrrhizee composita (compound 
mixture of liquorice), commonly called brown mixture, consists of 
the pure extract, acacia, sugar, each 3 parts; paregoric, 12 parts; 
antimonial wine, 6 parts; sweet spirit of nitre, 3 parts; water, 70 
parts ; dose, foss ; an excellent preparation in the treatment of 
bronchitis without fever. Liquorice-extract enters into the compo- 
sition of several troches already noticed, and it is used as an 
excipient for pills. 

LYCOPODIUM. 

This is the sporules of Lycopodium clavatum or Club-moss, 
and other species of Lycopodium {Nat. Ord. Lycopodiaceae), low, 
creeping perennials, found in the dry woods of Europe and America. 

Description and Constituents. — The stem is from 2 to 4 feet 
long, with numerous short ascending branches, having linear awl- 
shaped leaves ; the sporules are found in reniform sporangia of the 
long peduncle which terminates the fertile branches. It consists of 



570 MATERIA MEDICA AND THERAPEUTICS. 

a fine, yellow, inflammable powder; odorless, tasteless, and not 
wetted by water, and contains fixed oil and volatile bases. 

Effects and Uses. — It is employed as a dusting powder, and, 
as it is not wetted by water, makes an excellent application for 
excoriated surfaces, intertrigo, etc. It is particularly useful to pre- 
vent the irritation or chafing caused by the urine or alvine dejec- 
tions coming in contact with the tender or inflamed perinaeum and 
nates, in infantile cases. 

It is also used in pharmacy to prevent the adhesion of pills. 

CETRARIA. 

Cetraria islandica, or Iceland Moss {Nat. Ord. Lichenes), is 
a foliaceous, erect lichen, from two to four inches high, found in the 
northern latitudes and mountainous districts of the new and old 
continents. It is obtained principally from Norway and Iceland, 
but is said to be abundant also in New England. 

Fig. 59. 




CETRARIA ISLANDICA. 



Description and Constituents. — As found in the shops it 
consists of irregularly-lobed and channelled coriaceous leaves, 
fringed at their edges with rigid hairs, of a brownish or grayish- 
white color, darker on the upper surface, and sometimes marked 
with blood-red spots. It is almost odorless, and has a bitter, 
mucilaginous taste; its powder is whitish-gray. It gives up its 



DEMULCENTS— CHONDRUS. 571 

virtues to boiling water, and consists chiefly of a kind of amyla- 
ceous matter (which is colored blue by iodine, and is termed 
lichenin — C 12 H 20 O ]0 ), and a bitter principle termed cetrarin or cetraric 
acid (C 18 H 16 O s ); it contains, besides, other principles. 

Effects and Uses. — Iceland moss is a demulcent tonic, and is 
also highly nutritious. It is adapted to cases requiring a light 
aliment combined with a mild and acceptable tonic ; and from its 
demulcent properties has a soothing influence in inflammations of 
the various mucous membranes. It is chiefly used in chronic affec- 
tions of the pulmonary and digestive organs, as bronchitis and diar- 
rhoea, in the form of decotion (decoctum cetrarice), which may be taken 
ad libitum. By maceration in water or a weak alkaline solution, 
Iceland moss may be deprived of its bitter principle ; 2nd it is then 
used as a mild nutritive demulcent. 

CHONDRUS. 

Chondrus crispus, Carrageen or Irish Moss (Nat. Ord. Algae), 
is a marine alga found chiefly on the west coast of Ireland, and also 
on the coast of New England. It is also obtained from Chondrus 

mammilosus. 

Fig. 60. 



^S^MTs! 







CHONDRUS CRISPUS. 



Preparation, Description and Constituents. — It is prepared 
for use by washing, bleaching, and drying. As found in the shops 
it consists of fronds from two to three or four inches long, mostly 
yellowish or dirty-white but intermixed with purplish-red portions, 



572 MATERIA MEDIC A AND THERAPEUTICS. 

nearly inodorous, and of a mucilaginous taste. It swells up in 
warm water, and is almost entirely dissolved when boiled. Its chief 
constituent is a peculiar mucilaginous principle, for which the term 
Carrageenin has been proposed ; and it contains also some mucus, 
resins, etc. 

Effects and Uses. — It is a very agreeable nutritive demulcent, 
useful in bowel complaints and pectoral affections. 

Administration. — It may be given in the form of decoction 
(Sss to water Ojss boiled to Oj) flavored with lemon-juice and 
sugar ; or it may be made with milk or cream into blanc-mange, 
which forms an excellent light diet for the sick. By saturating 
two superimposed layers of wadding with a solution of chondrus, 
and drying them in a stove after they have been submitted to a 
strongpressure, a sheet of the consistence of card-board is produced, 
which, when soaked in hot water, makes an excellent poultice. 

AMYLUM— STARCH. 

This term is applied by the Pharmacopoeia to the fecula of the 
seed of Triticum vulgare, the well-known wheat (Nat. Ord. Gram- 
inaceae). It is a proximate principle, however, which pervades the 
vegetable kingdom, being found in various parts of plants, especially 
in seeds, tubers and bulbous roots. 

Preparation, Microscopical Appearance and Tests. — It is 
obtained by bringing the substances in which it exists to a state of 
minute division, agitating or washing them with cold water, strain- 
ing or pouring off the liquid, and allowing it to stand until the fecula 
which it holds in suspension has subsided. It occurs as a white, 
opaque, odorless, tasteless, powder, or in columnar masses of a crys- 
talline aspect, and produces a peculiar sound when compressed be- 
tween the fingers. It is insoluble in alcohol, ether, and cold water. 
Examined under the microscope, starch is seen to consist of minute 
circular or lenticular granules, the laminae of which are arranged 
around a central point or hilum, varying in size and shape in the 
different varieties of amylaceous substances. The diameter of the 
wheat granule is about T oVo of an inch. The potato-starch granule 
is one of the largest, that of rice the smallest. The envelope of these 
granules is insoluble in cold water, but is ruptured by heat, so that 
the interior portion is exposed and becomes dissolved; hence starch 
is said to be insoluble in cold, but soluble in boiling water. Starch 
is C 6 H 10 O 5 , and is classed with the carbohydrates. By the action of 



DEMULCENTS— ANIMAL EATS. 573 

heat, or by long boiling with diluted sulphuric or hydrochloric 
acid, it is converted into dextrin, an isomeric soluble principle, and 
by the same process this may be converted into grape-sugar. The 
same change takes place in grains, after germination, through the 
agency of a nitrogenous principle termed diastase. The test for 
starch is iodine, which forms with starch-solution a rich blue iodide; 
nitric acid converts it into oxalic acid. 

Effects and Uses. — The starchy or farinaceous articles form 
an important group of nutrients. Their assimilation is effected by 
the albuminous principles of the digestive tube (salivin and pancre- 
atin), which change starch into grape-sugar, the conversion taking 
place in the mouth and duodenum. Starch is used externally as a 
dusting powder to excoriated surfaces ; to prevent chafing (starch 10 
parts, salicylic acid 3, and powdered soap-stone 8); to prickly heat 
with zinc oxide; as an emollient poultice, and in solution as a vehicle 
for laudanum in the form of enema. It is the antidote for iodine. 

Glyceritiim Amyli (Glycerite of Starch) (Plasma) contains 10 
per cent, of starch thoroughly mixed with glycerin and dissolved 
by the aid of heat. It is excellent as a vehicle for astringent appli- 
cations in ophthalmic surgery, and as an application to allay heat, 
burning and itching of the skin in scarlatina and smallpox; in the 
latter it is particularly pleasant to the patient, and has as much 
effect -in preventing pitting as any other application. It is used 
as a substitute for ointments, and is a good excipient for pills. 
Amylum iodatum {iodized starch) has been already spoken of (vide 
P- 452.) 

Ichthyocolla (Isinglass), prepared from the swimming bladder 
of Acipenser Huso (the sturgeon) and of other species of Acipenser 
(Class, Pisces; Ord., Sturiones) is the purest form of gelatin. Court- 
plaster (Emplastrum ichthyocollce) is made by coating thin silk with 
a solution of isinglass. Gelatin is also used as an article of diet, and 
is employed in pharmacy to make capsules for the administration of 
disagreeable medicines, and as a coating for pills. 

For external use, the animal fats are employed as emollients. 
When applied externally, they are absorbed and assimilated, and in- 
crease the body-weight ; hence inunctions have been practiced in 
wasting diseases, as phthisis, etc. They also reduce the temperature 
of the body in febrile conditions, and allay itching and irritation of 



574 MATERIA MEDICA AND THERAPEUTICS. 

the surface, and for this purpose they are employed in the exanthe- 
mata, as scarlet fever, measles, etc. They are also used as excipi- 
ents for other medicines, in making ointments, etc. 

Adeps {Lard) is the prepared fat of Sus Scrofa (the hog) 
[Class, mammalia; Ord., pachydermata) ; the internal fat of the 
abdomen is preferred, which is washed, melted and strained. Below 
the temperature of 90 it occurs as a soft, white solid, which for 
medicinal use should be free from saline matter. It consists of olein 
and stearin. 

Effects and Uses. — It is used in pharmacy as an addition to 
poultices, and as an inunction in the exanthemata, particularly 
scarlatina and measles. 

Administration. — Cerate (ceratum) is made by melting to- 
gether 70 parts of lard and 30 parts of white wax. Unguentum 
{ointment) is made by melting together 80 parts of lard and 20 
parts of yellow wax. Lard-oil (the olein of lard) is a good vehicle 
for anodyne-enemata. 

Adeps benzoinatus {benzoinated lard), formerly termed benzoin- 
ate d ointment, consists of benzoin 2 parts in 100 parts of lard. 

Lanolin (not official). This substance, the description of which 
is based on the investigations of Liebreich* (by whom it was in- 
troduced), Lassar,f Aubert,J W. G. Smith, § and Kinner, || is the 
purified fat of sheep's wool ; chemically, it is a fatty salt of choles- 
terin. It is not a secretion of the sebaceous glands, but a retro- 
grade metamorphosis of keratin. It is neutral, of slight odor, dark 
color, not readily decomposed, blends easily with glycerin and fats, 
has considerable capacity for mixing with water, and is not saponi- 
fiable. 

Local Effects. — Lanolin when applied to the skin acts as a 
bland lubricant. Liebreich {loc. cit.) states that corrosive sublimate 
mixed with lanolin and brought in contact with the skin soon pro- 
duces a metallic taste in the mouth. Lassar {loc. cit.) has shown, 
too, that cinnabar mixed with it penetrates more deeply into the 
skin than with other ointments. Aubert {loc. cit.), on the other 
hand, affirms that he was unable to obtain the constitutional effects 



* Berlin Klinische Wochen., No. 47, p. 761. f Ibid., No. 5, p. 75. 

1 " Congres de Chirurgie?' Paris, 1886, quoted. 

§ Brit. Med. Jour., 1886, p. 1106. 

\Journ. of Cutaneous and Venereal Diseases, 1886, p. 270. 



DEMULCENTS— OLEIC ACID. 575 

of atropine in lanolin rubbed on the skin; in fact, he considers it 
retards, rather than accelerates, absorption. The weight of experi- 
ence, however, now shows that it possesses considerable penetrative 
power. 

Medicinal Uses. — It is an excellent excipient with which to 
apply medicines to the skin; to assist the removal of scales, as in 
psoriasis ; to lubricate the cracks and fisures of eczema after the 
acute stage has been passed, and, in fact, wherever in the use of an 
unirritating, undecomposable ointment is indicated. It may be 
diluted with other fats and flavored with oil of lavender. 

Sevum (Suet) is the internal fat of the abdomen of Ovis 
Aries (the sheep) (Class, Mammalia; Ord., Ruminantia), purified by 
melting and straining. It is composed almost exclusively of stearin, 
but also contains some palmitin, olein and hircin. 

Cetaceum (Spermaceti) is a peculiar concrete fatty substance 
obtained from Physeter macrocephalus or spermaceti whale (Class, 
Mammalia; Ord., Cetacea). It consists almost entirely of cetyl 
palmitate (C 16 H 33 C 16 H 31 2 ) or cetin, but recently has been shown to 
contain also ethers of stearic, myristic and laurostearic acids ; and of 
the alcohols, lethal (C 12 H 26 0), methal (C 14 H 30 O), ethal (C 16 H 34 ) and 
stethal (C 18 H 33 0). Spermaceti cerate (ceratum cetacei) is made by 
melting together 10 parts of spermaceti and 35 parts of white wax, 
and then adding 55 parts of olive-oil, previously heated. Ointment 
of rose-water (see p. 195) contains spermaceti. 

Cera Flava (Yellow Wax) is a peculiar concrete substance 
prepared by Apis mellifica, the honey-bee (Class, Insecta; Ord., 
Hymenoptera). 

Cera Alba (White Wax) is yellow wax bleached. They are 
used chiefly in making cerates, ointments and plasters. 

acidum oleicum— oleic acid. 

Oleic acid (HCi 8 H 33 2 ) exists in nature combined with glycerin 
and olein. 

Preparation and Description. — It is obtained in an impure 
state as a secondary product at stearin-candle manufactories. To 
purify the acid, it is cooled to I4°F. and expressed; the solid 
portion melted and treated with lead protoxide ; the lead oleate is 
dissolved out by ether, decanted, and shaken with hydrochloric 



576 MATERIA MEDIC A AND THERAPEUTICS. 

acid, which decomposes it ; the ethereal layer is decanted and 
evaporated. The oleic acid thus obtained is still contaminated 
with a little oxyoleic acid, which is difficult to separate. Oleic 
acid is a yellowish oily liquid, which becomes brownish and rancid 
by exposure to the air, without smell or taste, soluble in alcohol 
and ether, but insoluble in water. 

Effects and Uses. — Oleic acid penetrates or soaks through 
the skin more readily than do the oils or fats. It is consequently 
employed as a vehicle in cutaneous medication, particularly in the 
form of the oleates. The oleates of the alkaline metals are soft 
soluble soaps ; those of the earthy metals are insoluble in water, 
but soluble in alcohol and ether. . - 

Oleic acid is used principally in preparing the oleates of vera- 
trine (vide p. 246) and of mercury (vide p. 434). Oleates of copper 
and zinc are also employed. 

OLEUM THEOBROMINE— OIL OF THEOBROMA. 

This oil, commonly known as Butter of Cacao, is the fixed 
oil expressed from the seed of Theobroma Cacao (Nat. Ord. Ster- 
culiacese), a handsome tree, from twelve to twenty feet in height, 
growing in Mexico, the West Indies, Central America and South 
America. The fruit is an ovate-oblong capsule or berry, half a foot 
in length, with a thick, coriaceous, ligneous rind, inclosing a whitish 
pulp, in which numerous ovate seeds are embedded, about the size 
of an almond. Separated from the matter in which they are en- 
veloped, these constitute the chocolate-nuts of commerce (seep. 130). 
They contain fixed oil (cacao butter\ theobromine , and other mat- 
ters. Theobromine is an alkaloid, analogous to caffeine. 

Preparation and Description. — Cacao-butter is obtained by 
expression, decoction or the action of a solvent. It occurs in 
whitish or yellowish oblong cakes, of the consistence of tallow and 
of an agreeable odor and taste. It contains a large proportion of 
stearin, also palmitin and olein. 

Effects and Uses. — It is employed in pharmacy for coating 
pills, and also largely in preparing suppositories, for which it is well 
adapted by reason of its consistence and blandness, and because it 
melts at the temperature of the body. It does not become rancid on 
exposure to the air. It may be used with advantage as an unguent 
in fever, to reduce the heat and allay the cutaneous irritation. 



DEMUL CENTS— GL YCERIN. 577 



GLYCERINUM— GLYCERIN. 

This is a substance which exists in oils in combination with the 
fatty acids (stearic, margaric, oleic, etc.), and is liberated from them 
when they unite with bases in the process of saponification. 

Preparation. — It was first obtained in the process for making 
lead-plaster, by mixing litharge (lead monoxide) with olive-oil and 
boiling water, by which the fatty acid unites with the lead and is 
precipitated, and the glycerin remains in solution. It is freed from 
any lead it may contain by means of a stream of sulphuretted 
hydrogen gas, and is afterward filtered through animal charcoal; 
or, as it is now usually made more directly, by decomposing fats 
and distilling by steam under high pressure. Glycerin (C 3 H 5 3HO), 
or Glyceric Alcohol, is the hydrate of Glyceril, Glycil, or Propenyl, 
and is a triatomic alcohol. 

Description. — It is a thick, syrupy liquid, colorless or straw- 
colored, unctuous to the touch, inodorous, of a sharp, sweet taste, 
and of neutral reaction. When pure its sp. gr. is 1.260, when it 
contains 95 per cent, of absolute glycerin; the Pharmacopoeia 
directs its sp. gr. to be 1.250. It is soluble in alcohol and water, 
but is insoluble in ether and chloroform, and does not evaporate 
when exposed to the air, but absorbs one-half its weight of water. 
It readily reduces potassium permanganate, with which it is incom- 
patible. It has remarkable solvent properties, dissolving iodine, 
bromine, the alkalies, tannic and other vegetable acids, pepsin, a 
large number of neutral salts, and many organic principles. Official 
solutions of medicinal substances in glycerin are termed glycerites 
(glycerita). 

Effects and Uses. — Glycerin is a bland and unirritating sub- 
stance. It has the capacity of diffusing itself freely over and 
through organic matter, incorporating itself between organic mole- 
cules, by which it is absorbed and appropriated. It has been used 
internally as a demulcent, but the weight of opinion is against its ef- 
ficacy as a nutrient. It is as a topical application that it is chiefly 
employed. As an enema in dysentery ; to soften hardened mucus in 
the upper air-passages, as in chronic nasal catarrh ; in various cuta- 
neous affections, as chaps ; in deafness attended with dryness of the 
meatus ; and as a vehicle or solvent for active medicines, glycerin is 
a valuable article. In gynaecological practice the introduction of a 
pledget of cotton soaked in glycerin within, the vagina as far as the 
37 



578 MATERIA MEDICA AND THERAPEUTICS. 

cervix is followed by a watery discharge which relieves neighboring 
congestion, and hence is an agent of some value in mild metritis; or 
equal parts of carbolic acid and glycerin may be applied to the 
uterine cavity. Guzzo* recommends the following treatment to 
prevent extensive cicatrization following burns and scalds: apply to 
the entire burned surface a piece of lint thickly spread with cold 
cream and covered with a compress two inches thick saturated with 
glycerin (freshly wet from three to six times a day; the whole 
dressing to be changed daily), and covered with a dry compress 
and bandage. This treatment failed in only one of fifty-one 
cases, f 

Recently attention has been called to small rectal injections 
of glycerin (f5^-j) as a safe, sure, and speedy means of opening 
the bowels in obstinate constipation. It seems to act by irritating 
the sentient rectal nerves, leading to powerful reflex peristalsis, 
which ends in defecation (Althaus,j; Anacher § and Mayer ||). The 
liquid may be introduced by a urethral rubber-syringe. 

Glyceritum amyli (glycerite of starch) has already been consid- 
ered (see p. 573). 

Glyceritum vitelli (glycerite of yolk of eggs) (glyconin) is made by 
mixing thoroughly 45 parts of fresh yolk of egg with 55 parts of 
glycerin. It is a good vehicle for the administration of cod-liver 
oil, a few drops of some aromatic being added as a flavoring in- 
gredient. 

PETROLATUM. 

Petrolatum is a mixture of hydrocarbons obtained by distilling 
the lighter and more volatile portion from American petroleum, and 
purifying the remainder. Mineral oils have been known from time 
immemorial, and were obtained by the ancients from Sicily, the 
Ionian Islands and Persia ; later they were found in various parts 
of Europe, Asia and North America, but did not become an im- 
portant article of commerce until 1859, when the first oil-well was 
sunk near Titusville, in Pennsylvania. 

Description and Chemistry. — Petrolatum is a yellowish, 
transparent, semi-solid fatty substance, melting at from 104 to 
124 F., insoluble in water and cold alcohol, more so in boiling ab- 



* Gaillard's Med. Jour n., March, 1882. J Brit. Med. Journ., Dec. 24, 1887, p. 1379. 
f Arch Dermat., Oct., 1882. $ Deuts. Med. Wochen., Sept. 15, 1887, p. 823. 

|| Med. News, Feb. 25, 1888, p. 201. 



DEMUL CENTS— COLLODION. 579 

solute alcohol; readily soluble in ether, chloroform, oil of turpen- 
tine, benzine, and the fixed and volatile oils. It consists principally 
of the hydrocarbons of the marsh-gas series. It has been intro- 
duced into the Pharmacopceia as a substitute for vaseline, cosmoline, 
and other copyrighted preparations, which consist of mixtures of 
paraffine and the heavier petroleum oils, and, like them,' possesses 
the advantage over the animal oils and fats of not becoming rancid. 

Effects and Uses. — When taken internally, in large doses, 
petrolatum is said to cause giddiness and oppression, with palpita- 
tion and headache. It seems to be well borne by the stomach, and 
causes no diarrhoea. It is employed only externally as an inunction 
in scarlet fever, measles, roseola, and cutaneous affections such as 
lichen and chaps, to blistered surfaces, and it forms an admirable basis 
or excipient for ointments and drugs. It is an excellent dressing 
for abrasions mixed with carbolic acid gr. v-x to oj. 

A liquid paraffine [oleum peirolati, not official), pure, or as a 
solvent for menthol (gr. ij to oj), camphor, etc., is used as a nasal 
or pharyngeal spray. 

PYROXYLINUM-PYROXYLIN. 

Preparation. — Pyroxylin, or Soluble Gun Cotton, is made by 
adding cotton (cellulin) to a mixture of nitric acid gradually added 
to sulphuric acid, and allowing it to macerate ; it is to be washed 
first with cold water, and then with boiling water, and after being 
drained on filtering paper it is dried by means of a water-bath. 

Chemistry. — Cellulin is (C 6 H 10 O 5 ) which when treated with 
(HN0 3 ) an< 3 (H 2 S0 4 ) is converted into dinitro-cellulose by the sub- 
stitution of 2 molecules of nitril (N0 2 ) for 2 atoms of its (H) form- 
ing pyroxylin. Pyroxylin has the appearance of ordinary cotton, but 
is harsh to the touch. It is insoluble in water and alcohol, but, 
when freshly prepared, it dissolves in ether, forming collodion ; 
it is liable to decomposition if kept for some time. 

COLLOD1UM— COLLODION. 

Preparation. — This is a solution of pyroxylin (4 per cent.) in 
stronger ether (70 per cent.) and stronger alcohol (25 per cent). 
Collodion is a slightly opalescent, syrupy liquid, with a strong 
ethereal smell. By long standing it deposits a layer of fibrous 
matter, and becomes more transparent; this layer should be rein- 
corporated by agitation before the collodion is used. 

Effects and Uses. — When applied to the skin the solvent 



580 MATERIA MEDIC A AND THERAPEbTICS. 

evaporates, and it forms a colorless, transparent, flexible and 
strongly contractile film. This film proves antiphlogistic by dri- 
ving the blood away from a part, limiting effusion and promoting 
absorption, and at the same time acts as an admirable emollient by 
protecting an inflamed surface from the action of the air. 

It is a useful application to ulcers, fissures and skin-diseases and 
abraded surfaces. Marked improvement has followed its daily use 
in that disfiguring keloid of the face which sometimes follows small- 
pox. It is employed also in surgery as a substitute for adhesive 
plaster, and in pharmacy as a vehicle for other medicines. Iodized 
collodion (a very good solution of iodine for external application) 
contains from ten to twenty grains of iodine in a fluidounce of 
collodion. It has been recently applied to the scalp with success 
in functional alopecia* Collodion fo*^ and morphia sulphate 
gr. ij-v is a useful application to herpes zoster. 

Collodium Flexile {Flexible Collodion) is made by mixing 92 per 
cent, of collodion, 5 per cent, of Canada turpentine and 3 per cent, 
of castor-oil. This is a softer, more pliable and more elastic pre- 
paration, useful in cases where the strongly contractile power of 
ordinary collodion is objectionable. It is a good application in 
eczema and excoriations. Collodion, in all forms, is to be kept in 
well-stoppered bottles. 

Collodium Stypticum {Styptic Collodion) contains 20 per cent, of 
tannic acid, 5 per cent, of alcohol, 20 per cent, of stronger ether and 
55 per cent, of collodion. It is an excellent styptic application. 

LIQUOR GUTTA-PERCHA— SOLUTION OF GUTTA-PERCHA. 

This is a solution of 9 per cent, of gutta-percha in 91 per cent, 
of commercial chloroform. In preparing it lead carbonate is em- 
ployed to free it from coloring matter. It is a clear, colorless or 
nearly colorless solution, and should be kept in well-stoppered glass- 
vials. By the evaporation of the chloroform, this proves an admira- 
ble application to inflamed ox abraded parts, in skin-affections, chaps, 
etc. ; it is .also an excellent protective coating to parts threatened 
with bed-sores or liable to excoriations, and for the retention of 
medicinal substances upon the skin in dermal therapeutics, as 
chrysarobin (q. v.) to ringworm. 

*Brit. Journ. of Dermatology, July, 1892. 



DEMUL CENTS—SUGAR. 581 

LIQUOR SODII SILICATIS— SOLUTION OF SODIUM SILICATE. 

Preparation and Description. — This solution (commonly 
known as Solutio?i of Soluble Glass) is made by fusing together fine 
sand and dried sodium carbonate, and dissolving the product in hot 
water. It is a semi-transparent, colorless, viscid liquid, without 
smell but having a sharp, alkaline taste, which, on drying, becomes 
a transparent glass-like mass. 

Effects and Uses. — It has been employed as a local applica- 
tion in erysipelas, but is chiefly used in making permanent dressings 
in the treatment of fracture. For this purpose it should be applied 
upon a roller bandage thoroughly impregnated with the sodium 
silicate of the consistency of mush, freshly prepared in a basin, 
with a little water. The parts, if hirsute, should be shaved ; and to 
prevent too much pressure upon the superficies it is well to first 
apply a flannel-bandage. Successive layers of the plaster-bandage 
are then applied and allowed to harden. Generally three or four 
layers will be sufficient. Inequalities in the dressing may be filled 
in by smearing on the moistened silicate. 

SACCH ARUM— SUGAR . 

Sugar is a principle diffused through the vegetable world under 
many forms, all distinguished by a sweet taste. They are divided 
into two chief groups — Cane-Sugar and Grape- Sugar. Cane-sugar 
is the product of Saccharum officinarum {Nat. Ord. Graminaceae), 
a native of tropical countries, cultivated most successfully in the 
West Indies, the Sandwich Islands, and to some extent in Louisiana. 
It has a general resemblance to Indian corn. 

Preparation.— The juice of the sugar-cane is extracted by 
crushing and expressing the stalks ; it is then boiled with quick- 
lime, strained, and reduced by evaporation to a thick syrup, which 
is cooled and granulated in shallow vessels. Raw sugar is refined 
by the agency of animal charcoal. Cane-sugar is also made in 
France and Belgium from the beet-root. When pure, cane-sugar is 
white, crystallized in translucent, double oblique prisms, very sweet, 
soluble in one-third its weight of water, in alcohol, but not in ether. 
At a heat of 220 F. it melts and cools into a glassy, amorphous 
mass, known as barley- sugar ; from a strong solution it can be 
made to crystallize slowly upon a string as rock-candy. 

The uncrystallizable portion, which is drawn off in the granu- 



582 MATERIA MEDICA AND THERAPEUTICS. 

lation of sugar is molasses or treacle, a dark brownish-black, syrupy 
liquid. 

Grape-sugar is the sugar of grapes and other acid fruits ; it is 
also found in the liver and blood of mammalia, and in the urine of 
diabetes mellitus. It may be procured artificially by acting on 
starch with diluted sulphuric acid. It occurs as whitish or grayish- 
white, non-crystalline masses, or as a dense transparent syrup. 

Chemistry. — Cane-sugar (C 12 H 22 O u ) combines with alkalies to 
form saccharates. Nitric acid with heat converts it into oxalic acid. 
Grape-sugar (C 6 H 12 6 .H 2 0), when boiled with an alkali, is trans- 
formed into the acid of molasses, melassic acid; mixed with solution 
of potassium hydrate and a weak solution of cupric sulphate, it 
attracts oxygen, and causes the precipitation of a reddish, cuprous 
oxide (Cu 2 0). 

Effects and Uses. — Sugar, especially in the form of barley- 
sugar, is an excellent demulcent to relieve catarrhal irritation ; 
much of the cough-relieving action of cough-syrups is due to the 
sugar they contain. It abates thirst, and is used to flavor refrigerant 
drinks. For pharmaceutical purposes sugar is much employed, for 
its agreeable taste, and also as a preservative of vegetable substances, 
and to protect mineral medicines from oxidation. Molasses is 
slighly laxative as well as demulcent. 

Mel {Honey). This saccharine liquid, the familiar product of 
the bee (Apis Mellificd), best used in the form of mel despumatum 
(clarified honey), is a slightly laxative article of food, and is used in 
pharmacy, and as an agreeable demulcent ingredient in gargles. 

Saccharum Lactis (Sugar of Milk) (C 12 H 2 20 n .H 2 0), the sacchar- 
ine principle of milk obtained from whey, is used as a bland non- 
nitrogenous article of diet. It is used in preparing abstracts and to 
insure the admixture of powders, as in pulvis ipecacuanha et opii. 

SACCHARIN* (NOT OFFICIAL). 

Chemistry. — This, a recently introduced therapeutic agent, is a 
product of the coal-tar derivatives, being derived from the aromatic 
group of hydrocarbons, and is chemically anhydro-orthosulphamin- 
benzoic acid (Fahlbergf). It is a white, crystalline powder, unalter- 

* Brit. Med. Journ., Oct. 16th, 1887. f Amer. Chem. Joum., 1879 ; Vol. 1, p. 436. 



COLORING A GENTS- SAFFRON. 583 

able at ordinary temperatures, of an acid reaction, slightly soluble 
in cold water, dissolves in alcohol, glycerin and ether, and unites 
with the alkalies to form definite salts. Its most characteristic 
property is sweetness y saccharin being in this respect about 300 
times greater than that of cane-sugar. 

Effects and Uses. — When taken internally \ even in large 
quantity (5ss-gr. lxxx), it is innocuous. Dogs fed on it together 
with their ordinary diet, according to Egasse,* did not increase in 
weight, nor was any alteration either in the quantity, specific grav- 
ity, or proportion of urea in their urine, found. It passes through 
the economy undecomposed, since it can be detected in the urine 
unchanged, but it has not been discovered in the saliva or feces. 
In its exit by the kidneys it exerts a decided influence in restraining 
the alkaline fermentation of the urine, hence it has proved valuable 
to correct the fetor of the urine in chronic cystitis. 

It is chiefly employed as a substitute for sugar in obesity, and in 
diabetes mellitus, gr. j-ij being sufficient to sweeten the tea, coffee, 
sugar or food ; and as a corrective of the taste of certain bitter 
medicines, as quinine (see p. 158). 

ORDER IV.— COLORING AGENTS. 

These 'are employed exclusively for pharmaceutical purposes. 
The following articles enter into official preparations, to which they 
are intended to communicate their peculiar color : — 

CROCUS— SAFFRON. 

This is the stigmas of Crocus sativus (Nat. Ord. Iridaceae), a 
small perennial plant, a native of Greece and Asia Minor, but now 
cultivated all over Europe and in our own country. In Lancaster 
county, Pennsylvania, it has been raised to considerable extent. 

Description and Constituent.— The stigmas are an inch or 
more in length, of a rich deep orange color, a peculiar aromatic 
odor and a warm, pungent, bitter taste; they contain a principle 
termed saffranin or polychroit (C^H^O^). 

Effects and Uses. — Saffron is now admitted to possess little, 
if any, medicinal activity, and is used only to impart color and 
flavor to official preparations. The tincture contains 10 per cent, of 
saffron. 

* Bull. Gen. de Therapy Oct. 30th, 1888, p. 337 ; an elaborate article. 



584 MATERIA MEDICA AND THERAPEUTICS. 



SANTALUM RUBRUM— RED SAUNDERS. 

This is the wood of Pterocarpus santalinus, a large tree of 
India and Ceylon [Nat. Ord. Leguminosae). 

Description and Constituents. — It comes in roundish or 
angular billets, internally of a blood-red color, externally brown, 
of little smell or taste; in the shops it is found in the form of chips, 
raspings or coarse powder. It contains a resinoid matter, santal 
(C 8 H 6 3 ), pterocarpin (Ci 7 H 16 5 ) and santalic acid. 

Effects and Uses. — It is employed solely to give color to 
spirits, tinctures, etc. 

COCCUS-COCHINEAL. 

This is an insect, termed Coccus cacti [Class, Insecta; Ord. 
Hemiptera), of Mexico and Central America, naturalized in TenerifTe 
and other places. 

Description and Constituent. — The female insect, dried, 
constitutes the article of the shops. It occurs in the form of 
roundish or somewhat angular grains, about an eighth of an inch 
in diameter, convex on one side, concave or flat on the other, and 
wrinkled. Two varieties are distinguished, one reddish-gray, the 
other nearly black, known as silver grains and black grains. It has 
a faint, heavy odor and a bitter, slightly acidulous taste ; its color- 
ing principle is carminic acid (C 17 H i8 O 10 ). 

Effects and Uses.— It is employed chiefly to color tinctures, 
ointments, etc. 

ORDER V.— ANTHELMINTICS. 

Anthelmintics are medicines which promote the destruction 
and expulsion of worms from the alimentary canal. When a medi- 
cine simply causes the expulsion of the parasite it is called a Vermi- 
fuge; when it causes the death of the worm, a Vermicide. The 
vermifuges are spigelia, azedarach, calomel and the drastic purga- 
tives ; the vermicides, chenopodium, santonica, aspidium, granatum, 
oleum terebinthince, koosso, kamala and pepo. They act in different 
ways ; some weaken or destroy the worms by a direct poisonous 
influence, as male-fern, and others by mechanical means, kamala for 
example. The drastic cathartics exert an anthelmintic effect by the 
increased peristalsis and purgation which they induce in and from 
the intestinal canal. As thread-worms chiefly occupy the rectum, en- 



A NTH EL MINTICS—SPIGELIA . 



585 



emata are used to destroy them, as quassia infusion (q. v.), cod-liver 
oil (q. v.), and carbolic acid (q. v.). 

SPIGELIA. 

Spigelia, called also Pinkroot, is the rhizome and rootlets of 
Spigelia marilandica, or Carolina Pink [Nat. Ord. Loganiaceae), an 

Fig. 6i. 




SPIGELIA MARILANDICA. 



herbaceous indigenous plant, found chiefly in our Southern and 
Southwestern States. 



5S6 MATERIA MEDIC A AND THERAPEUTICS. 

Description and Constituents. — The rhizome is horizontal, 
thick, bent, purplish-brown, branched on the upper side with cup- 
shaped stars, on the lower numerous thin, brittle, light-colored 
rootlets. It must not be confounded with the underground portion 
of the Phlox Carolina, also called Carolina pink. The stems are 
numerous, from a foot to a foot and a half high, of a purplish 
color, furnished with sessile, opposite, ovate-lanceolate leaves, and 
terminate in spikes, bearing funnel-shaped flowers, of a rich carmine 
color externally and orange-yellow within, which appear from May 
to July. The rhizome and rootlets, as found in the shops, consist 
of numerous slender, wrinkled, branching, brownish fibres attached 
to a dark-brown caudex, and have a faint, peculiar smell and a 
sweetish, slightly bitter taste; their activity is diminished by time. 
Boiling water extracts its virtues, which are thought to depend 
upon a bitter-principle ; it contains also volatile oil, resin, a little 
tannic acid, etc. 

Physiological Effects. — In ordinary doses spigelia often 
proves anthelmintic without any sensible effect on the system. In 
larger doses it purges and sometimes vomits; and in excessive doses 
it operates as a narcotic, producing vertigo, dilated pupils, flushing 
of the face, etc. The following results were obtained by Hare* with 
spigelia on dogs. Three ounces of the fluid extract caused constant 
retching, pupillary dilatation, internal strabismus, rapid respiration, 
progressive muscular palsy, coma and death. Injected into the 
veins it slowed the heart's action, the retardation being chiefly due 
to central inhibitory stimulation. As death approaches, its depress- 
ing action on the respiratory centre is marked. It is less apt to 
occasion narcotic effects when it acts on the bowels, and hence it is 
usually combined with or followed by cathartics. 

Medicinal Uses. — As an anthelmintic against lumbrici (or 
round-worms) it is considered one of the most reliable articles we 
possess. Before its exhibition a restricted diet and an active 
cathartic should be prescribed. 

Administration. — Dose of the powdered root, 5j-ij for an adult; 
for a child three or four years old, gr. x-xx to be repeated night 
and morning for three or four days, and followed by a brisk ca- 
thartic; calomel is sometimes combined with it. The fluid extract 
may be given in the dose of f5j or more ; to a child two years old, 

* Med. News, March 12, 5887. 



A XTHELMINT7CS— CHENOPODIUM. 



587 



ten drops may be given. Under the name of ivorm-tea, prepara- 
tions containing spigelia and cathartics are kept in the shops, as in 
the following formula : spigelia, 5ss ; manna, 5J ; senna and fennel, 
each 5ij ; savine, gr. xl; to be infused in Oj of boiling water, and 
fSss given to a child two years old, t. d. 

CHEN0P0DIU3I. 

Chenopodium, or American Wormseed, is the fruit of Che- 
nopodium ambrosioides, or Jerusalem Oak {Nat. Ord. Chenopo- 



FlG. 62. 




CHENOPODIUM AMBROSIOIDES. 

diaceae), an indigenous, herbaceous / perennial plant (found most 
abundantly in the Southern States), from two to five feet high, 
with alternate oblong-lanceolate, sinuated and toothed yellowish- 
green leaves, with numerous small flowers of the same color ar- 
ranged in long terminal panicles. 



588 MATERIA MEDICA AND THERAPEUTICS. 

Description and Constituents. — Chenopodium, as found in 
the shops, is in small spherical grains, not larger than a pin's head, 
of a dull greenish-yellow or brownish color, a peculiar offensive 
smell, and a rather aromatic, pungent taste. Their sensible and 
medicinal properties are owing to a volatile oil {Oleum Cheno- 
podii), obtained by distillation. 

Effects and Uses. — Chenopodium is a very efficient anthelmin- 
tic, particularly adapted to the expulsion of Inmbrici from children. 

Administration. — Dose, gr. xx-xl for a child two or three 
years old, in molasses, night and morning, for three or four days, to 
be followed by a brisk cathartic. The oil is more used than the 
fruit ; dose, gtt. v-x for a child, in emulsion with sugar or in cap- 
sules. The expressed juice of the leaves and a decoction made 
with milk are also used. 

santonica. 

The unexpanded flower-heads of Artemisia maritima {Nat. 
Ord. Compositae), a native of Persia, and of other species of arte- 
misia, are used as an anthelmintic (in the dose of gr. x-xxx), under 
the name of Levant Wormseed. 

Description and Constituents.— They resemble small seed in 
appearance, are about a line in length, oval, obtuse at both ends, of 
a greenish-brown color, a strong, somewhat terebinthinate odor, 
and a bitter, camphoraceous taste. They contain volatile oil, resin, 
and a peculiar principle termed santonin, which is prepared by di- 
gesting santonica and lime in diluted alcohol, adding acetic acid, 
crystallizing, boiling with alcohol, digesting the tincture with animal 
charcoal, filtering and crystallizing. 

Santoninum {Santonin) is a neutral principle (C 15 H 18 3 ), and 
occurs in colorless, shining, flattened prisms, without smell, nearly 
tasteless at first, but after a time bitter ; it becomes yellow on ex- 
posure to the light. It is nearly insoluble in cold water, soluble in 
250 parts of boiling water, in 40 parts of cold and 3 parts of boiling 
alcohol, and in 160 parts of ether, and is readily soluble in chloroform. 

Physiological Effects. — Krauss* experimentally ascertained 
that it was absorbed by the blood, where it exists for a time 
undecomposed ; he states, too, that it affects the central nervous sys- 
tem, in small doses as a narcotic; in large, as a tetanizer, the symp- 

* Inaug. Diss. Tubingen, 1869, Ueb. d. Wirk. d. Santonins, etc. 



ANTHELMINTICS— AZEDARA CH. 589 

toms being (occasionally but not invariably) vomiting, giddiness, 
ocular scintillations, incoherence of ideas, stupor, coldness of the 
skin, with clammy perspiration, and, finally, tetanic convulsions. A 
remarkable effect produced by santonin, even in moderate amounts, 
is a change in the field of vision, so that objects are seen as if 
through a yellow medium. When allowed to remain in the system, 
santonin is supposed to be converted into a substance termed 
xanthopsin, which is eliminated through the kidneys, producing a 
yellow discoloration of the urine, and probably it is this transforma- 
tion /which gives rise to the poisonous symptoms occasionally 
noticed.* Hence, santonin is best administered with calomel or 
other purgatives. W. G. Smithf detected santonin in his own 
urine, but he could not find it in the saliva. 

Toxicology. — In large doses it is capable of producing serious 
and sometimes fatal poisoning,! -gr. vj. having killed a child aged 5 
years thirty-five minutes after ingestion. 

Medicinal Uses. — Santoninum is the anthelmintic constituent 
of santonica, and is a most efficient remedy for lumbrici. It should 
be followed in a few hours by castor-oil, or other purgative. 

Administration. — Dose, gr. ss-v two or three times a day, in 
the form of syrup, in pill or capsule. 

Sodii Santoninas [Sodium Santoninate) ^NaQsH^O^H^O) is 
made by adding santonin as long as it is dissolved, to a hot solution 
of caustic soda and allowing the liquid to evaporate slowly. It is 
rapidly absorbed after ingestion, appearing in the urine in half an 
hour. It produces effects similar to those of santonin, but of a 
milder grade (Krauss, loc. cit.). 

Trochisci Sodii Santoninatis (Troches of Sodium Santoninate) ; 
each troche contains gr. j of sodium santoninate, with sugar, traga- 
canth, and orange-flower water. 

AZEDARAClf. 

This is the bark of the root of Melia Azedarach, or Pride of 
China (Nat. Ord. Meliaceae), an Asiatic tree cultivated extensively 



* Some persons would seem to be peculiarly susceptible to the action of this drug, as Dr. 
H. Morris has seen all the poisonous effects above described, except the convulsions,- pro- 
duced in a woman 35 years of age, to whom he had administered two doses of gr. % of 
santonin with gr. j of calomel at an interval of 2 hours. 

f Dublin Quart. Journ. of Med. Sci., 1870, p. 296. 

% St. Thomas' Hosp. Reports, Vol. X. 



590 MATERIA MEDICA AND THERAPEUTICS. 

as an ornamental tree in our Southern States. It has a bitter, 
nauseous taste, and yields its virtues to boiling water. 

Effects and Uses. — Its effects are said to resemble those of 
spigelia, and it is used against lumbrici as a vermifuge. 

Administration. — -The decoction is the preferred form of ex- 
hibition (Sjv in water Oij, boiled to Oj) ; dose for a child, f§ss 
every two or three hours, till it affects the stomach and bowels ; or 
night and morning for several days. 

ASPIDIUM. 

Aspidium filix-mas, or Male Fern, and A. marginale (Nat. Ord. 
Filices) are plants found in both hemispheres, from Greenland to 
Natal, and from Japan to Peru, though not indigenous in the east- 
ern United States. They have a perennial horizontal root, from 
which spring numerous annual oval, lanceolate, acute, bright-green 
pinnate fronds or leaves, from a foot to four feet in height, grouped 
together in the form of a base ; the leaflets are deeply lobate, oval, 
crenate at their edges, and gradually diminish from the base of the 
pinna to the apex. 

Description and Constituents. — The rhizome is the portion 
used. It is a long, cylindrical caudex, covered with portions of the 
stipes, and as found in the shops it is generally broken into fragments 
of a brown color externally, internally yellowish-white or greenish, 
with a peculiar feeble odor and a sweetish, bitter, astringent, nau- 
seous taste. It deteriorates by keeping. It contains filicic acid (C u 
Hi 8 5 ), on which its medicinal properties are said to depend ; also 
volatile oil, fixed oil, resin, tannic and gallic acids, etc.; ether is the 
best solvent to extract its virtues. Besides the above, Daccomo* 
has isolated a waxy-substance (Ci3H 26 0), aspidol (C20H34O), and two 
resins. He failed to find the essential oil obtained by Schoonbroodt.f 

Toxicology. — A fatal case of poisoning % by aspidium has been 
reported, with symptoms of choleraic diarrhcea. The patient was 
given 5j y 2 of an ethereal extract by mistake. The post-mortem ap- 
pearances were intense congestion of the stomach, with ecchymoses 
beneath the mucous membrane and blood-clots on the mucous 
surface. 



* Annali di Chimica, Agosto, 1887, P« 69. An elaborate investigation. See also Am. 
Journ. Pharm., 1889, p. 144. 

j Jour, de Med. de Chir. et de Ph irm., Bruxelles, 1868, p. 64. 
j Lancet, Oct., 1882, p. 630. 



ANTHELMINTICS— POMEGRANA TE. 591 

Effects and Uses. — Aspidium possesses tonic and astringent 
properties ; but its chief use is to cause the expulsion of tcznia, which 
it destroys by a specific action. J. Harley * states that it does not 
kill the entozoon, but simply detaches it from the intestinal wall, 
and causes its evacuation by the force of the peristaltic contractions 
induced by its action. Its efficacy as a vermicide has been long 
and well attested. 

Administration. — Dose, of the powder, 5j-iij, in electuary or 
emulsion, night and morning for one or two days. The oleo-resin 
(pleoresina aspidii) is the best preparation ; it is a dark, thick liquid, 
of a bitterish, nauseous, slightly acrid taste ; dose, f5ss-j night and 
morning for a day or two, to be followed by a cathartic. As a sedi- 
ment is deposited from it on standing it should be shaken before 
use. The administration of the tasniacide agents should always 
be preceded by a twenty-four hours' fast. 

GRAN ATUM— POMEGRANATE. , 

The bark of the root of Punica Granatum is used for the ex- 
pulsion of taenia. - 

Chemical Constituent. — It contains pelletierine (C 8 H 15 NO)> 
which, according to the later researches of its discoverer, M. Tariret,| 
is a compound body, consisting of several alkaloidal principles. 

Fig. 63. 




PUNICA GRANATUM, ROOT-BARK. 

. Effects and Uses. — Pelletierine in large doses is said to cause 
paralysis of the motor-nerves, without affecting sensation, and to 
dilate the capillaries. Pomegranate is an active tceniacide, but is 
apt to cause nausea and sometimes vomiting. Pelletierine tannate 
may be given in doses of gr. v-xv on an empty stomach, and is 
best preceded by a purgative. If the drug do not move the 
bowels, a brisk cathartic should follow its administration. Berenger- 
Feraud % observed that the exhibition of a drastic, as jalap, or 

* " Royle's Materia Med.," p. 370. f Bull. Gen. de Therap., XCVIII, p. 316. 

% Bull. Gen. de Therap., Aout. isieme, p. 120, 1888. 



592 MATERIA MEDICA AND THERAPEUTICS. 

scammony, with pelletierine, decidedly aided this agent in the ex- 
pulsion of taenia. 

Besides its tceniacide action, granatum is a powerful styptic. 

Administration. — It is given in decoction (Sij to water Oij> 
boiled to Oj) ; dose, f5ij or more. 

Oleum Terebinthinae (Oil of Turpentine) {see p. 405) is used as 
a remedy for tcenia and other worms. Dose, fSj, combined with or 
followed by castor oil. 

Calomel (see p. 436) is a valuable anthelmintic, given in 
cathartic doses. 

Brayera {Koosso). The female inflorescence of Brayera an- 
thelmintica (Nat. Ord. Rosaceae), a native of Abyssinia, have been 
introduced into European practice as an anthelmintic, under the 
name of Koosso. 

Description and Constituents. — They occur in broken, com- 
pressed clusters of a greenish-yellow color, a fragrant balsamic 
odor, and a faint taste which after a time becomes acrid and disa- 
greeable. They yield gum, resin, fatty matter, tannic acid, and 
about three per cent, of a peculiar principle termed kosin (C 31 H 38 O l0 ), 
a yellow-white crystalline resin, without smell or taste, to which its 
anthelmintic properties are attributed (Bedell*). 

Effects and Uses. — In large doses brayera may cause vomit- 
ing, colic and diarrhoea. It is used against tcenia, which it kills, and 
should be followed by an active purge. Brayera is best given upon 
an empty stomach, after a previous evacuation of the bowels. 

Administration. — Extractum Brayerce Fluidum (Fluid Extract 
of Brayera); dose, f5ij-ijv. The infusion (not official) is made with 
6 parts of the powder and 100 parts of boiling water. The kosin 
being insoluble it is to be taken unstrained. 

kamala. 

This is the glands and hairs obtained from the capsules of 
Mallotus philippinensis (Nat. Ord. Euphorbiaceae), a small tree of 
Hindostan and the East India islands. 

Description and Constituents. — It is an orange-red, granu- 
lar, inflammable powder, with little smell or taste, insoluble in cold, 

* " Biennial Retresp. etc., New Syd. Soc," 1867-8, p. 475. 



ANTHELMINTICS— PUMPKIN-SEED. 593 

and nearly so in boiling water, forming, with alcohol, ether or 
chloroform, red solutions, due to the extraction of the resin. It 
consists chiefly of resinous substances, to one of which, soluble in 
ether, and considered the active constituent, the name of rottlerin 
(C 22 H 20 O 6 ) has been given. 

Effects and Uses. — Kamala (formerly called Rottlerd) is a 
gastro-intestinal irritant. It is a highly-esteemed tceniacidem India, 
and has been introduced as such into Europe and our own country. 

Administration. — Dose of the powder, 31— ij , suspended in 
syrup. A tincture (Syj to alcohol Oj) is given in the dose of f5j-jv. 
Castor-oil should be taken after the medicine. 

PEPO— PUMPKIN-SEED. 

The seed of Cucurbita Pepo, or common Pumpkin {Nat. Ord. 
Cucurbitaceae). 

Fig. 64. 




CUCURBITA PEPO. 

A. Divided. B. Entire. 

Description and Constituents. — The seeds are oval, flattish, 
grooved, 9 lines long by 5 or 6 in breadth, of a light brownish-white 
color, a sweetish, oily taste, and an aromatic smell. They owe their 
activity to a principle soluble in ether, chloroform, and especially 
alcohol. 

Effects and Uses. — This is probably the most efficacious 
remedy known for the destruction and expulsion of tape-worm. 

Administration.— Dose, Sj-ij of the fresh seeds, deprived of 
their outer envelope, beaten to a paste with finely-powdered sugar, 
and diluted with water or milk, may be taken after a twenty-four 
hours' fast, and followed in two or three hours by a dose of castor- 
oil. A fluid extract, made with alcohol and glycerin, is probably 
the best preparation; dose fSss-j. 



• 38 



APPENDIX. 



SIGNS AND ABBREVIATIONS USED IN PRESCRIPTIONS. 

R , Recipe, take. 

aa, Ana (ava), of each. 

ft), Libra, libra, a pound, pounds. 

^ , Uncia, uncice, an ounce, ounces. 

3 , Drachma, drach?nce, a drachm, drachms. 

^, Scruptdus, scrupuli, a scruple, scruples. 

O, Octavius, octavii, a pint, pints. 

f 3 , Fluiduncia,fluiduncice, a fluidounce, fluidounces. 

f 3 , Flnidrachma,fluidrachmce, a flui drachm, fluidrachms. 

TTX? Minimum, minima, a minim, minims. 

Ad 2 Vic, Ad duas vices, at two takings. 

Ad Lib., Ad libitum, at pleasure. 

Add., Adde, addantur, add, let be added. 

Altern. Horis, Altemis horis, every other hour. 

Aq. Destil., Aqua destillala, distilled water. 

Aq. Ferv., Aqua fervens, hot water. 

Aq. Fluvial., Aquajluvialis, river- water. 

Aq. Font., Aqua fontana, spring- water. 

Aq. Pluv., Aqua pluvialis, rain-water. 

Bus Ind., Bis indies, twice a day. 

Bull., Buliiat, bulliant, let it or them boil. 

Cap., Capiat capiendum, let the patient take it ; it must be taken. 

Chart., Chartula, chartulce, a small paper, or papers. 

CocHLEAT., Cochleatim, by spoonfuls. 

COCH. Mag., Cochleare magnum, a tablespoonful. 

CoCH. Med., Cochleare medium, a dessertspoonful. 

Coch. Parv., Cochleare parvum, a teaspoonful. 

Col., Cola, coletur, strain, let it be strained. 

ColLYR., Collyrhim, an eye-water. 

CoMP., Compositus, compounded. 

Cong., Congius, Congii, a gallon, gallons. 

C. M. S., Cras mane sumendtis, to be taken to-morrow morning. 

C. N., Cras node, to-morrow night. 

DECOC, Decocttim, a decoction. 

De D. in D., De die in diem, from day to day. 

Dieb. Altern., Diebus alter?iis, every other day. 

594 



APPENDIX. 595 

Dli.„ Dilue, dilutes, dilute, diluted. 

Dim., Dimidius, one-half. 

Div., Divide, divide. 

1)., Dosis, a dose. 

Elec, Electuarium, an electuary. 

Enem., Enema, enemata, a clyster, clysters. 

Exhib., Exkibeatur, let it be administered. 

F. H., Fiat haustus, let a draught be made. 

Fil., Filtra, filter. 

Ft., Fiat,fiant, let there be made. 

Garg., Gargarysma, a gargle. 

Gr., Granum, grana, a grain, grains. 

Gtt., Gutta, guttce, a drop, drops. 

Guttat., Guttatim, by drops. 

Haust., Haustus, a draught. 

Ind., Indies, daily. 

Inf., Infunde, pour in. 

Infus., Infusum, an infusion. 

In J., Injiciatur, let it be injected. 

Jul., Julepus, julepum, a julep. 

M., Misce, mix. 

Mane, in the morning. 

Mist., Mistura, a mixture. 

MlC. Pan., Mica panis, crumb of bread. 

No., A T umero, in number. 

Omn. Hor., Omni hord, every hour. 

Omn. Bid., Omni biduo, every two days. 

Omn. Bih., Omni bihord, every two hours. 

Omn. Man., Omni mane, every morning. 

Omn. Nocte, 0?nni node, every night. 

Omn. Quadr. Hor., Omni quadrante horce, every quarter of an hour 

Ph., Pharmacopoeia. 

POCUL., Poculum, a cup. 

P. R. N., Pro re natd, as the symptoms may call for. 

Pulv., Pulvis, a powder. 

Q. P., Quantu77i placeat, as much as you please. 

Q. S., Quantum sufficit, enough. 

QUOR., Quorum, of which. 

Redig. IN Pulv., Redigatur in pulverem, let it be reduced to powder. 

Repet., Repetatur, repetantur, let it or them be repeated. 

S., Signa, write. 

S. A., Secundum artem, according to art. 

Semih., Semihora, half an hour. 

Sign., Signatura, a label. 

Ss., Semis, a half. 

Sum., Sume, sumendus, let it be taken. 

Tabel., Tabella, a lozenge. 

Troch., Trochiscus, a lozenge. 

Trit., Tritura, triturate. 



NDEX. 



Bold-face type indicates chief reference to each article. 



Abbreviations, table of, 594 . 

Abies excelsa, 542 

Abscesses; application of remedies to, 

76 
Absinthe, 148 
Absinthin, 148 
Absinthium, 147 
Absinthol, 148 
Abstracta, 58 
Abstracts, 58 
Abstractum belladonna, 100 

hyoscyami, 154 

Valerianae, 177 
Acacia, 561 
Aceta, 63 
Acetanilide, 504 
Acetum lobelise, 306 

opii, 89 
Acid, acetic, 353, 258 

anthemic, 146 

boheic, 129 

caffeo-tannic, 129 

camphoric, 124 ' 

camphoronic, 121 

cincho-tannic, 150 

citric, 258 

cocatannic, 130 

columbic, 142 

hydrocyanic, 306 

ferulaic, 122 

gentisic, 141 

kinovic, 150 

meconic, 82 

ophelic, 143 

quinine sulphate, 157 

tropic, 103 

valerianic, 127 
Acida mineralia, 176-555 

vegetabilia, 257 
Acids, vegetable, 54, 55, 257 
Acidum aceticum, 257 

arseniosum, 455~554 

benzoicum, 508 

boricum, 492 

carbolicum, 497 
crudum, 497 

chromicum, 553 

citricum, 257 

gallicum, 188 

hydrobromicum dilutum, 301 

596 



hydrochloricum, 179 
dilutum, 180 

hydrocyanicum dilutum, 306 

lacticum, 181 

nitricum, 178 

dilutum, 179 

nitro-hydrochloricum, 180 
dilutum, 181 

oleicum, 575 

phosphoricum, 181 
dilutum, 181 

salicylicum, 512 

sulphuricum, 177 

aromaticum, 178 
dilutum, 178 

sulphurosum, 490 

tannicum, 186 

tartaricum, 257 
Aconine, 235 
Aconite, 235 
Aconitine, 235 
Aconitum, 235 

Napellus, 235 
Actual cautery, 41 
Acupuncture, 34, 37 
Adeps, 574 

benzoinatus, 574 
Adonidine, 282 
Adonis vernalis, 282 
JEther, in 

fortior, in 
Aluminous principle, 54 
Alcohol, 213 

amylic, 214 

cerylic, 145 

dilutum, 218 

potassa, 552 
Alder buckthorn, 359 
Alkaline carbonates, 386 

mineral waters, American, 478 

mineral waters, European, 479 

salts, 386 
Alkaloids, 54 
Allium, 401 
Allspice, 227 
Aloes, 355-420 

Barbadoes, 355 

Cape, 355 

hepatic, 355 

Socotrine, 355 



INDEX. 



597 



Alteratives, 78, 424 

Althaea, 566 

Alum, 2ii, 329-556 

dried, 211-212 

waters, 212 
Alumen, 211 
Aluminii sulphas, 212 
American hellebore, 241 
American wormseed, 587 

preparations of, 220 
Ammoniac, 123 
Ammoniacum, 123, 420 
Ammoniae aqua, 221 
fortior, 221 

praeparata, 220 

benzoas, 509 

bromidum, 300 

carbonas, 222 

chloridum, 467 

iodidum, 45 1 

phosphas, 468 

praeparata, 482 

bromide, 300 

chloride, 467 

phosphate, 468 

preparations, 482 

valerianate, 128 

elixir of, 128 (foot-note). 
Amygdalin, 310 
Amyl hydrate, 310 

nitris, 310 

nitrite, 310 
Amylum, 572 

iodatum, 573 
Anaesthetics, 78 
Anamirta paniculata, 268 
Aniline, 495-504 
Animal fats, 573 
Anise. 234 

oil, 234 

star, 234 

water, 234 
Anisum, 234 
Anode, 45 
Anodynes, 79 
Antacids, 78, 471 
Anthelmintics, 78, 584 
Anthemis, 146 

nobilis, 146 
Antifebrin, 504 
Antimonii oxidum, 249 

et potassii tartras, 249 

sulphidum, 252 

sulphuratum, 252 
Antipyretics, 485 
Antipyrine, 526 
Antiseptics, 78-485 
Antispasmodics, 78, 121 
Apiol, 423 
Apocynacese, 393 
Apocynum, 393 
Apollinaris water, 479 



Apomorphinae hydrochloras, 328 
Apomorphine, 328 
Apothecaries' measure, 67 

weight, 60 
Aqua, 560 

ammoniae, 550 

camphorae, 1 26 

chlori, 487 

cinnamomi, 225 

creosoti, 504 

destillata, 560 

menthae piperita^, 232 
viridis, 232 

rosae, 195 
Aquae, 60 

Arkansas Hot Springs, 41 
Arctostaphylos uva ursi, 414 
Argentii iodidum, 209 

nitras, 206 

dilutus, 208 
fusus, 208-552 

oxidum, 208 

praeparata. 206 
Aristol, 531 
Aristolochia reticulata, 143 

serpentaria, 143 
Aristolochiaceae, 143 
Arnica, 247 
Aromatics, 222 
Arrack, 219 

iodidum, 464 

prseparata, 455 
Artanthe elongata 412 
Artemisia absinthium, 147 
Asafetida, 121-420 
Asafoetida, 121-420 
Aspidium, 590 

filix-mas, 590 
Aspidol, 590 
Aspiration, 34 
Aspirator, 37 
Astringents, 78-185 
Atomization of fluids, 73 
Atomizers, 73 

Sajous' modification, 74 

Sass's, 74 

Siegele's, 75 

Snowden's, 74 
Atropa belladonna, 95 
Atropine, 96, 101 

sulphate of, 1 01 
Aurantii amari cortex, 23 1 

dulcis cortex, 231 
Auri et sodii chloridum, 444 
Aveling's apparatus for transfusion, 76 
Azedarach, 589 

Bagneres-de-Bigarre Spring, 484 
Ballston Spa waters, 481 
Balsamodendron myrrha, 416 
Balsamum Peruvianum, 419 
Tolutanum, 419 



598 



INDEX. 



Bandages, 34, 36 

elastic, 36 
Barosma betulina, 413 
Basham's mixture, 170 
Basic quinine sulphate, 157 

ferric sulphate, 159 
Basilicon ointment, 407 
Bath County Hot Springs, 41 
Baths, 40 

cold, 42 

contra indications for, 40 

hot, 40 

air, 41 

Sitz, 40 

tepid alkaline, 40 

warm, 40 
Baunscheidtismus, 37 
Bearberry, 414 

Bedford Chalybeate Spring, 479 
Belladonna, 95 
Belladonnine, 96 
Benzine, 495 
Benzoinum 417 
Benzol, 495 
Benzoic acid, 495-508 

aldehyde, 310 
Berberaceae, 143 
Berberine, 142, 143 
Bismuth 

preparations of, 209 

valerianate, 210 
Bismuthi et ammonii citras, 210 

praeparata, 209 

subcarbonas, 210 

subnitras. 209 
Bitter almond water, 310 

cucumber, 368 

orange, 231 
Bitter extractive, 54, 56 
Bitters, aromatic, 140, 143 

astringent, 140, 149 

simple, 140 
Black drop, 89 

haw,«3i8 

pepper, 224-544 

snakeroot, 285 
Blennorrhetics, 78, 385, 387-398 
Blisters, 544 
Bloodletting, 420 
Bloodroot, 326 
Blue-flag, 367 
Blue gum-tree, 145 

Pill, 373 
Bolus, 60 

Bone phosphate of calcium, 464 
Boric acid, 492 
Brayera, 592 
Bromine, 490, 554 
Bromum, 554 
Broom, 397 
Brown mixture, 569 
Brucine, 260, 261 



Bryonia, 362 
alba, 362 
dioica, 362 

Bryony, 362 

Buchu, 413 

Butter of cacao, 

Butternut, 355 



576 



Caffea, 129 
Caffeina, 129 
Caffeine, 129, 136 

citrate, 130 

valerianate, 120 
Calabar bean, 290 
Calabarine, 290 
Calamus, 228 
Calcareous water, 484 
Calcii bromidum, 301 

carbonas praecipitatus, 482 

chloridum, 466 

hypophosphis, 465 

phosphas praecipitatus, 464 

praeparata, 482 
Calcium chloride, 466 

hypophosphite of, 465 

preparations of, 482 
Calendula, 384 
Calisaya bark, 149 
Calomel, 373, 592 
Calor, 40 
Calumb, 142 
Calumba, 142 
Calx chlorata, 488 

sulphurata, 492 
Cambogia, 370 
Campeachy-wood, 192 
Camphor, 123 

artificial, 124 
Camphora, 123 
Camphora Cinnamomum, 123 

monobromata, 126 
Canadian hemp, 393 
Cannabinine, 108 
Cannabin, 108 
Cannabis Americana, ic6 

Indica, 106 

sativa, 106 
Cannabene, 108 

hydride, 108 
Cantharidin, 547 
Cantharides, 420-545 
Cantharis, 397, 545 

vesicatoria, 545 

vittata, 550 
Capon Springs, 478 
Capsaicin, 223 
Capsicum, 223-542 
Carbolic acid, 495, 497 
Carboligni, 537 
Carbonic acid water, 561 
Cardamom, 228 
Cardamomum, 228 



INDEX. 



599 



Carminic acid, 584 
Carolina jasmine, 314 
Carthagena barks, 150 
Carum, 234 
Caryophyllin, 226 
Caryophyllus, 226 
Cascara sagrada, 360 
Cascarilla, 148 
Cascarillin, 149 
Cassia, 357 

acutifolia, 357 

aethiopica, 357 

elongata, 357 

Fistula, 333 

lanceolata, 357 

obovata, 357 
Castanea, 196 

vesca, 196 
Castor oil, 333 
Cataplasmata, 65 
Cataplasms, 65-559 
Catechin, 190 
Catechu, 190 
Catechu-tannic acid, 190 
Cathartics, 78-320 
Cathode, 45 
Catoosa Springs, 484 
Caustic potassa, 552 
Cauterants, 551 
Cauterization, 41 
Cayenne pepper, 223 
Celandine, 365 
Centreville Springs, 484 
Cephaelis Ipecacuanha, 322 
Cera alba, 575 
Cerium flava, 575 
Cerata, 65 
Cerates, 65 

Ceratum camphorae, 126 
Ceratum cantharidis, 548 

resinae, 407 
Cerii oxalas, 210 

oxalate, 210 
Cetaceum, 575 
Cetraria, 570 
Chalybeates, 164 
Chalybeate waters, North America, 174 

Europe, 175 
Chamomile, 145 

German, 145 
Champagne, 218 
Charcoal, 537 
Charta cantharidis, 550 
Chartse, 60 
Chelidonium, 365 
Chenopodium, 587 
Chian turpentine, 404 
Chimaphila, 415 

umbellata, 415 
Chinocine, 496 
Chinoidin, 159 
Chinoidinum, 159 



Chinoline, 496 
Chirata, 143 
Chiratin, 143 
Chittem bark, 361 
Chloral, 292 

alcoholate, 293 

hydrate, 293 
Chloride of lime, 488 
Chlorinated lime, 488 
Chlorine, 487 

water, 487 
Chlorodyne, 118 (foot note) 
Chloroform, 115 
Chloroformum, 115 

purificatum, 115 

venale, 115 
Chocolate, 130 
Choline, 108 

Chondodendron tomentosum, 413 
Chondrus, 571 
Chromic acid, 553 

anhydride, 553 
Chrysarobin, 557 
Chrysarobinum, 557 
Chrysophan, 352 
Chrysophanic acid, 352 
Cimicifuga, 285 
Cinchona, 149 

alkaloids of, 150 

calisaya, 149 

condaminea, 150 

flava, 149 

micrantha. 149, 150 

officinalis, 149 

ovata, 149 

rubra, 149 

succirubra, 149 
Cinchoneae, 149 
Cinchonicine, 151 
Cinchonidinae sulphas, 159 
Cinchonidine, 150, 152 
Cinch onina, 150 
Cinchoninae sulphas, 159 
Cinchonine, 150, 151 
Cinnamic acid, 225 
Cinnamomum, 225 

zeylanicum, 225 
Cinnamon, 225 

cassia, 225 

Ceylon, 225 
Circumstances modifying the effects of 

medicines, 57, 68 
Citrus aurantium, 231 

vulgaris, 231 
Classification of medicines, 77 
Claviceps purpurea, 269 
Cloves, 226 
Club moss, 569 
Clysters, 75 
Coca, 130 
Cocaine, 130, 13 1 
Cocaine, hydrochl orate, 1 31 



600 



INDEX. 



Cocculus Indicus, 268 

palmatus, 142 
Coccus, 584 
Cochineal, 584 
Codeine, 80, 81, 91 
Cod-liver oil, 452 
Coffea arabica, 129 
Coffee, 129 
Cohosh, 285 
Coil, primary, 45 

secondary, 45 
Colchicum, 389 
Cold, 39, 41 

compresses, 42 

douche, 42 

injections, 43 

liquids, 42 

pack, 42 

wet sheet, 42 
Collodium, 579 

flexile, 580 

stvpticum, 580 

cum cantharide, 549 
Colly ria, 72 
Colocynth, 368 
Colocynthis, 368 
Colombin, 142 
Coloring agents, 78, 583 
Colombian bark, 150 
Columbo, 142 
Condy's fluid, 487 
Confectiones, 60 
Confections, 60 
Conhydrine, 287 
Conidia, 269 
Conine, 287 
Conium, 287 
Conserves, 60 
Copaiba, 407 
Copper, preparations of, 202 

sulphate of, 202, 329, 550 
Coriandrum, 234 

sativum, 234 
Cornacese, 160 
Cornutin, 271 
Cornus, 160 

circinata, 160 

florida, 160 

sericea, 160 
Corrosive sublimate, 489 
Cotton, 276 

borated, 276 

boro-, 276 

carbolized, 276 

iodo-, 276 

iodoform, 276 

root, bark of, 276 

salicylated. 276 

seed oil, 565 

styptic, 169 
Couch-grass, 396 
Cranesbill, 193 



Cream of tartar, 386, 346 

Creasotum, 502 

Cresson Springs, 174 

Creta praeparata, 483 

Crocus, 583 

Crot on -chloral hydrate, 295 

Croton Eluteria, 148 

oil, 371 
Crowfoot, 193 
Cryptopine, 82 
Cubeba, 410 
Cubebic acid, 410 
Cuca, 130 
Culver's root, 359 

physic, 359 
Cupri acetas, 202 

praeparata, 202 

sulphas, 203 
Curarine, 317 
Curine, 317 
Current, primary, 45 

secondary, 45 
Cyanhydric acid, 306 
Cydonium, 567 
Cymene, 234 
Cymol, 124 
Cypripedium, 128 

parviflorum, 128 

pubescens, 128 

Dandelion, 395 
Datura stramonium, 101 
Daturine, 102 
Decocta, 62 
Decoctions, 62 
Deer-berry, 230 
Delphinium staphisagria, 248 
Demulcents, 78-558 
Depresso-motors, 287 
Derivatives of phenyl, 494 
Dermatol, 537 
Deshler's salve, 407 
Dewees's carminative, 123 
Diachylon ointment, 201 
Dialyzed iron, 460 
Diaphoretics, 78-377 

alterative, 380 

nauseating, 377 

refrigerant, 377 

stimulating, 377 
Digestion, 61 
Digestive ferments, 162 
Digitalein, 278 
Digitalin, 278 
Digitalis, 277 

purpurea, 277 
Digitorin, 278 
Digitoxin, 278 
Dipterocarpacese, 124 
Dispensatory, 53 
Displacement, 6( 
Distilled waters, 60 



INDEX. 



601 



Diuretics, 78-385 

Dobell's solution, 74 

Dogwood, 160 

Donovan's solution, 464 

Dorema ammoniacum, 1 23 

Dover's powder, 89 

Drachm, 66 

Drastic cathartics, 360 

Drops, 67 

Dryobalanops camphora, 124 

Duboisia, 105 

myoporoides, 105 
Duboisine, 105 
Dulcamara, no 
Dulcamarin, no 
Dupuytren's pomatum, 550 

Eccritics, 78-321 
Ecgonine, 130 
Effleurage, 51 
Elaterin, 370 
Elaterinum, 370 
Electric bath, 43 
Electric itas, 43 
Electricity, 39, 43 

faradic, 43, 44 

frictional, 43 

galvanic, 43 

induced, 43, 44 

magnetic, 43 

static, 43 

voltao -magnetic, 43 
Electro-magnetic machine, 44 
Electrodes, 45 
Electrolysis, 50 
Electuaries, 60 
Elettaria Cardamomum, 228 
Elutriation, 59 
Emetics, 78-321 
Emmenagogues, 78-420 
Emollients, 558 
Emplastra, 65 
Emplastrum ammoniaci, 123 

cum hydrargyro, 123-430 
Emplastrum belladonnas, 100 

ferri, 167 

galbani, 123 
Emplastrum hydrargyri, 430, 433 

opii, 89 

picis Burgundicae, 543 
Canadensis, 543 
cum cantharide, 543 

plumbi, 65-201 
Endermic application of medicines, 71 
Enemata, 75-374 

anodyne, 376 

anthelmintic, 375 

astringent, 375 

emollient, 376 

forced, 375 

laxative, 375 

nutrient, 376 



Enemata, purgative, 375 

Enepidemic application of medicines, 71, 

Epidemic application of medicines, 71 

Epispastics, 544 

Epsom salt, 343 

Ergot, 269 

Ergota, 269 

Ergotinine, 271 

Errhines, 72 

Erythroxylaceae, 130 

Erythroxylon, 1 30 

coca, 130 
Escharotics, 551 
Eserine, 292 
Ether, in 

stronger, in 
Ethereal anaesthetics, III 

refrigerants, 386-255 
Ethyl bromide, 120 
Eucalyptol, 145 
Eucalyptus, 145 

globulus, 145 
Eugenin, 226 
Euonymus, 367 
Eupatorium, 146 

aromaticuin, 146 

perfoliatum, 146 

teucrifolium, 146 
Euphorbiaceae, 148 
Evacuants, 420 
Exalgine, 507 
Excito-motors, 260 
Extracta. 64 

fluida, 63 
Extracts, 64 

acetic, 64 

alcoholic, 64 

watery, 64 
Extractum aromaticum fluidum, 228 

belladonnse alcoholieum, 100 
fluidum, 100 

calumbae fluidum, 142 

cannabis indicae, 109 
fluidum, 109 

cinchonas, 156 
fluidum, 157 

cypripedii fluidum, 128 

dulcamaras fluidum, 1 1 1 

erythroxyli fluidum, 131 

eucalypti fluidum, 145 

eupatorii fluidum, 147 

gentianae, 142 
fluidum, 142 

glycyrrhizae, 569. 

guaranas fluidum, 136 

hyoscyami alcoholieum, 104 
fluidum, 104 

lactucarii fluidum, 90 

lupulini fluidum, no 

malti, 219 

opii, 88 

pruni Virginianas fluidum, 162 



602 



INDEX. 



Extractum quassiae, 141 
fluidum 
Scutellariae fluidum, 128 
serpentariae fluidum, 145 
stramonii, 102 

fluidum, 102 
Valerianae fluidum, 127 

False angustura bark, 260 
Faradic electricity, 43 
Faradization, 44 
Fennel oil, 234 

water, 234 
Fermenta, 486 
Ferri carbonas saccharatus, 167 

carbonatis, massa, 167 

chloridum, 169 

citras, 172 

et ammonii citras, 173 

et ammonii sulphas, 174 

et ammonii tartras, 174 

et potassii tartras, 171 

et quininae citras, 173 

et strychninae citras, 173 

hypophosphis, 172 

iodidum saccharatum, 171 

lactas, 173 

oxalas, 172 

oxidum hydratum, 167 
cum magnesia, 167 

phosphas, 171 

praeparata, 164 

pyrophosphas, 172 

sulphas, 168 

exsiccatus, 168 
praecipitatus, 168 

valerianas, 1 74 
Ferric sulphate, solution of, normal, 169 
Ferruginea, 164 
Ferrum, 164 

dialysatum, 174 

reductum, 166 
Ferula galbaniflua, 123 

Narthex, 121 

Scorodosma, 121 

Sumbul, 320 
Flaxseed, 564 

oil, 33 6 
Fluid extracts, 63 
Fluidounce, 67 
Fluidrachm, 67 
Fceniculum, 234 

vulgare, 234 
Fonticuli, 36 
Frangula, 359 
Frangulin, 359 
Fraxinus ornus, 331 

rotundifolia, 331 
Freezing mixtures, 120 
Frictions, 34, 36 
Fuller's alkaline, 475 
Fused silver nitrate, 552 



Galbanum, 123, 420 
Galla, 189 
Gallic acid, 188 
Gallon, 67 
Galvanism, 43 
Galvano-cautery, 17 
Gamboge, 370 
Gargarismata, 73 
Gargles, 73 
Garlic, 401 
Gases, 65 
Gaultheria, 230 
Gelatin, capsules, 60 
Gelsemine, 315 
Gelsemium, 315 
Gentian, 141 

yellow, 141 
Gentiana, 141 

lutea, 141 
Gentianaceae, 141, 143 
Gentiopicrin, 141 
Gentisin, 141 
Geranium, 193 

maculatum, 193 
Ginger, 227-544 

black, 227 

Jamaica, 227 

white, 227 
Glauber's salt, 344 
Glucosides, 54, 55 
Glycerin, 577 
Glycerinum, 577 
Glycerita, 64 
Glycerites, 64 
Glyceritum amyli, 573-578 

vitelli, 578 
Glycyrrhiza, 567 

echinata, 568 

glabra, 567 
Glycyrrhizin, 568 
Glycyrrhizinum ammoniatum, 568 
Golden seal, 266 

Gondret's vesicating ointment, 551 
Gossypii radicis cortex, 275 
Gossypium, 276 

herbaceum, 275 
Goulard's cerate, 549 

extract, 200 
Granatum, 591 

Granulated effervescing salts, 59 
Granulation, 59 
Granville's lotion, 550 
Gray powder, 429 
Green soap, 556 

Griffith's anti-hectic mixture, 168 
Grindelia, 319 
Ground-holly, 415 . 
Guaiac, 381 

wood, 381 
Guaiaci lignum, 381 

resina, 381 
Guaiacum, 381-420 



INDEX. 



603 



Guaiacum wood, 381 
Gum, 54, 55 

arabic, 561 

resina, 54, 55 

Hamamelis, 193 
virginica, 193 

Heartsease, 332 
Heat, 40 

Hebra's ointment, 201 
Hedeoma, 233 

pulegioides, 233 
Hedeomol, 233 
Hematics, 78, 424 
Hematinics, 78, 424 
Hematoxylon, 192 

campechianum, 192 
Hemlock, 287 
Hemp, American, 106 

Indian, 106 
Henbane, 102 
Herapathite, 151 
Herapath's test, 151 
Hirudo decora, 35 

medicinalis, 35 
Hoffman's anodyne, 138 
Homatropine, 100 
Hope's camphor mixture, 126 
Hops, 109 
Hot-air bath, 41 

bath, 40 

bottles, 40 

bricks, 40 

foot bath, 40 
Hot iron, 41 

water, 40 
Humulus, 109 

Lupulus, 109 
Huxham's tincture, 157 
Hydrargyri chloridum corrosivum, 43 1 
489, 555 

mite 374, 430, 435 

cyanidum, 431, 441 

iodidum rubrum, 441, 490 
viride, 431, 441 

oxidum flavum, 430, 434 
rubrum, 430, 433 

praeparata, 425 

subsulphas flavus, 431, 442 

sulphidum rubrum, 431, 443 
Hydrargyrum ammoniatum, 431, 442 

cum creta, 430, 433 
Hydrastine, 266 
Hydrastis, 266 

canadensis, 266 
Hydrochinone, 512 
Hydroquinone, 512 
Hygienic remedies, 23 
Hyoscine, 103 

hydrochlorate, 105 
Hyoscyaminae sulphas, 104 
Hyoscyamine, 103 



438, 



Hyoscyamus, 102 
Hyphae, 269 
Hypnone, 94 
Hypnotics, 79 

Hypodermic application of medicines, 7 1 
syringe, 71 

Ice bag, 42 

bladder, 42 

cap, 42 

water, 42 
Iceland moss, 570 
Ichthyocolla, 573 
Ichthyol, 535 
Igasuric acid, 260 
Igasurine, 260 
Ignatia, 266 
Ilex Paraguaiensis, 136 
Ulicium, 234 

anisatum, 234 
Imponderable remedies, 39 
Incompatibility, 58 
Indian poke, 241 

tobacco, 304 
Infusa, 61 
Infusions, 61 
Infusum cinch onae, 1 56 

pruni Virginianse, 162 
Ingluvin, 163 
Inhalation, 65 
Injection, rectal, 75 
Inosit, 278 
Iodine, 445, 490 

ointment, 448 
Iodized starch, 452 
lodoformum, 528 
Iodol, 533 
Iodum, 445 

Ioduretted potassium iodide, 449 
Ipecac, 322 
Ipecacuanha, 322 
Ipecacuanhic acid, 323 
Iris, 367 

versicolor, 367 
Irish moss, 571 
Irritants, 78, 538 
Issues, 34, 36 

Taborine, 378 
Jalap, 360 
Jalapa, 360 
Jamestown weed, 1 01 
Japaconine, 236 
Japaconitine, 236 
[ateorrhiza (jalumba, 142 
Jerusalem oak, 587 
Jervine, 242 
Juglans, 355 
Juniperus, 396 

Kairin, 522 
Kamala, 592 



604 



INDEX. 



Kino, 190 

red, 191 

tannic acid, 191 
Kino'in, 191 
Krameria, 191 

triandra, 191 
Kramero-tannic acid. 



191 



Labarraque's liquid or fluid, 488 

Labile, 45 

Labiatae, 128-231 

Lactic acid, 181 

Lactuca virosa, 90 

Lactucarium, 90 

Lactucin, 90 

Ladies' slipper, 128 

Lady Webster pills, 357 

Lard, 574 

Las Vegas Springs, 41 

Laudanum, 89 

Lanolin, 574 

Lartigue's gout-pills, 392 

Lauraceae, 123 

Lavements, 71 

Lavendula. 231 

Laxatives, 330 

Ledoyen's disinfecting fluid, 201 

Leeches, 35 

Leopard's-bane, 247 

Leptandra, 359 

Lettuce-opium, 90 

Leuk Springs, 584 

Levant wormseed, 588 

Leyden jar, 43 

Licebane, 248 

Light, 39 

Lima bark, 150 

Lime solution, 482 

water, 482 
Linimenta, 64 
Liniments, 64 
Linimentum ammoniae, 542 

belladonnae, 10 1 

calcis, 483 

camphorae, 126 

cantharidis, 549 

chloroformi, 118 

plumbi subacetatis, 200 

saponis, 126 

sinapis compositum, 542 
Linseed oil, 564 
Linum, 564 

Liquidambar orientalis, 418 
Liquids, 58, 60 
Liquor acidi arseniosi, 464 

ammonii acetatis, 256 

arsenii et hydrargyri iodidi, 464 

calcis, 482 

ferri acetatis, 173 
chloridi, 167 
citratis, 172 
et quininae citratis, 173 



Liquor ferri nitratis, 172 

subsulphatis, 169* 
tersulphatis, 168 

gutta-perchae, 580 

hydrargyri nitratis, 443, 555 

magnesii citratis, 344 

pepsini, 163 

plumbi subacetatis, 200 

potassae, 473 

potassii arsenitis, 462 
citratis, 256 

sodae, 476 

chloratae, 488 

sodii arseniatis, 464 
silicatis, 581 

zinci chloridi, 205 
Liquores, 60 
Liquorice root, 567 
Litharge, 201 

plaster, 65 
Lithian mineral waters, 481 
Lithii benzoas, 481 

bromidum, 301 

carbonas, 480 

citras, 481 

praeparata, 480 

salicylas, 515 
Lithium preparations, 480 
Liver of sulphur, 338 
Lobelia, 304-329 
Lobelic acid, 304 
Local blood-letting, 35 
Logwood, 192 
London paste, 553 
Loxa bark, 150 
Lozenges, 60 
Lupulin, 109, no 
Lupulinum, no 
Lycopodium, 569 

Mace, 225 

Maceration, 61 

Maris,, 225 

Magistery of bismuth, 209 

Magnesia, 342 

alba, 342 

calcined, 342 

ponderosa, 342 
Magnesii carbonas, 342-482 

citras granulatus, 344 

praeparata, 482 

sulphas, 343 

sulphis, 491 
Magnesite, 343 
Magnesium preparations, 482 
Magnolia, 148 

acuminata, 148 

glauca, 148 

tripetala, 148 

umbrella, 148 
Magnoliaceae, 148 
Magnolin, 148 



INDEX. 



605 



Malates, 287 

Male fern, 590 

Mammalia, 136 

Mandrake, 363 

Mangani oxidum nigrum, 176 

prceparata, 175 

sulphas, 176-345 
Manna, 331 
Marrubium, 233 

vulgare, 233 
Marshmallow, 566 
Martial preparations, 164 
Massa hydrargyri, 374-430-431 
Massage, 39, 51 

a friction, 51 
Mate, 136 
Materia Medica, definition of, 33, 53 

animal, 54 

inorganic, 54 

organic, 54 
Matico, 412 
Matricaria, 146 

chamomilla, 146 
May-apple, 363 
Meadow-saffron, 389 
Mechanical remedies, ^3> 34 
Medicated waters, 61 
Mel, 582 

rosae, 195 
Melted butter, 336 
Menispermaceae, 142, 143 
Menispermine, 268 
Menispermum, 384 
Mentha piperita, 232 

viridis, 232 
Mercurial cathartics, 373 
Mercury, metallic, 425-430 

nitrate of, 431 
Methyconine, 287 
Methylene bichloride, 1 18 
Methyl ethylic ether, 1 19 

nonyl-ketone, 422 
Methylic ether, 119 
Methy-theobromine, 129 
Metrical system of weights, 66 

compared with troy weights, 67 
Mezereum, 383 
Mild acrid cathartics, 352 
Mineral acids, 176 
Mistura ammoniaci, 123 

asafcetidae, 122 

chloroformi, 118 

cretae, 484 

ferri composita, 168 

et ammonii acetatis, 170 

glycyrrhizae composita, 569 
Mistura potassii citratis, 256 
Misturae, 60 

Mitchell, Weir, treatment, 52 
Mixtures, 60 
Moccasin plant, 125 
Modus operandi of medicines, 56 



Monsel's solution, 169 
Morphinae acetas, 89 

hydrochloras, 89 

sulphas, 89 
Morphine, 80, 81 
Mortar, 59 
Moschus, 136 

moschiferus, 136 
Moxa, 41 
Mucilago, tragacanthae, 563 

ulmi, 566 
Mucous membranes; application of medi- 
cines to, 72 
Muscarine, 106 
Musk, 136 

artificial, 137 
; Mustard, 539 
Mycelium, 269 
Mydriatic alkaloids, 106 
Myotic alkaloids, 106 
Myristica, 225 
Myroxylon Pereirae, 419 
Myrrha, 416 
. Myrtaceae, 145 

Naphthaline, 496-517 

Naphthol, 510 

Narceine, 80, 81 
! Narcotics, 78 
j Narcotine, 80, 81 

Nervol, 542 
i Neurotics, 78 
] New Almaden Vichy, 175 
I Nicotine, 302 

Nicotiana tabacum, 301 

Nitro-benzine, 495, 504 

Nitro-glycerinum, 312 

Nitrous oxide gas, 119 

Normal quinine sulphate, 157 

Nutgall, 189 

Nutmeg, 225 

Nux vomica, 260 

Oak-red, 192 

Official, definition of term, 53 

Oil, olive, 323 

benne, 567 

camphor, 124 

erigeron, 393 

lemon, 259 

santal, 411 

theobroma, 130 

wine, 138 
Oils, fixed, 54, 55 

volatile, 54, 55 
Ointment, carbolic acid, 502 

rose water, 195 
Ointments, 64 
Oleata, 65 
Oleates, 65 

Oleatum hydrargyri, 430 
Oleic acid, 575 



606 



INDEX, 



Oleoresin, lupulin, no 
Oleoresinae, 64 
Oleoresins, 54, 64 
Oleum aethereum, 138 

amygdalae amarae, 310 
expressum, 333 

cajuputi, 227 

caryophylli, 227 

chenopodii, 588 

cinnamomi, 225 

copaibas, 411 

erigerontis, 393 

eucalypti, 145 

gossypii seminis, 565 

lavandulae, 232 
florum, 232 

lini, 564 

morrhuae, 452 

myristicae, 226 

o} iv «, 333 

pimentae, 227 

ricini, 333 

rutae, 421 

sabinae, 421 

santali, 411 

sesami, 567 

sinapis, volatile, 542 

succini, 137, 138 

terebinthinae, 384-542-592 

theobromae, 576 

thymi, 233 

tiglii, 37 1-55 1 
Ophelia chirata, 143 
Opium, 79 

alkaloids of, 80 

denarcotisatum, 88 
Orchidaceae, 128 
Origanum, 233 

vulgare, 233 
Ounce, 66 

Pale bark, 150 
Palma Christi, 333 
Pancreatin, 163 

saccharated, 163 
Pancreatinum, 163 
Pansy, 332 
Papain, 163 
Papaver, 79 

somniferum, 79 
Papaveraceae, 79 
Papaverine, 82 
Papaya, 163 
Papers, 60 
Paraguay tea, 136 
Paraldehyd, 91 
Paramenispermin, 268 
Paramorphine, 82 
Pareira, 413 
Parsley camphor, 423 
Partridge-berry, 231 
Parts to which medicines are applied, 71 



Pasque-flower, 246 
Paullinia, sorbilis, 136 
Pearl white, 209 
Pectin, 54, 55, 278 
Pepo, 593 
Pepper, 224 

white, 224 
Pepsin, 162 

wine of, 162 
Pepsinum, 162 

saccharatum, 162 
Percolation, 6 1 
Percolator, 61 
Pestle, 59 
Petrissage, 51 
Petrolatum, 65-578 
Pharmacological remedies, 52 
Pharmacology, 53 
Pharmacopoeia, 53 
Pharmacy, definition of, 53 
Phenyl, 495 

hydride, 496 
Phlebotomy, 34 
Phosphorus, 182 
Physostigma, 290 
Physostigminae salicylas, 292 
Phytolacca, 247 
Picraconatine, 235 
Picraena excelsa, 140 
Picropodophyllin, 365 
Picrosclerotin, 271 
Picrotoxinum, 268 
Pills, 59, 60 

compressed, 60 
Pilocarpine, 377 
Pilocarpus, 377 
Pilulae, 59 

et ferri, 174 

antimonii compositae, 252 

asafcetidae, 122 

ferri compositae, 168 

iodidi, 171 

galbani compositae, 123 

upii, 88 
Pimenta, 227 
Pinitus succinifer, 137 
Pinkroot, 585 
Pint, 67 
Piper, 224 

nigrum, 224 
Piperina, 224 
Piperine, 224 
Pipsissewa, 415 
Pix Burgundica, 542 

Canadensis, 543 

liquid a, 406 
Plasters, 65 
Plumbi acetas, 199 

carbonas, 201 

iodidum, 200 

nitras, 201 

oxidum, 201 



INDEX. 



60. 



Plumbi praeparata, 196 
Pneumatic aspiration, 37 
Podophyllotoxin, 365 
Podophyllum, 363 
Poison-nut, 260 
Poison-oak, 267 
Poke-berries, 247 

root, 241-247 
Poland Spring, 479 
Polygala senega, 398 
Polygonum hydropiperoides, 423 
Pomegranate, 591 
Poppy, black, 79 

white, 79 
Potassa, 552 
Potassa cum calce, 553 

sulphurata, 338 
Potassii acetas, 386 

bicarbonas, 475 

bichromas, 470-555 

bitartras, 346 

bromidum, 296 

carbonas, 474 

chloras, 469 

citras, 255 

cyanidum, 309 

et sodii tartras, 347 

hypophosphis, 465 

iodidum, 449 

nitras, 253 

permanganas, 486 

praeparata, 473 

sulphas, 346 

sulphis, 491 

tartras, 347 
Potassium, bichromate, 470 

chlorate, 469 

nitrite, 314 

permanganate, 486 
Poultices, 65-559 
Poultices, charcoal, 559 

flaxseed, 531 

laudanum, 560 

medicated, 559 

yeast, 559 
Pound, 66 
Powders, 58 
Precipitated calcium, 482. 

phosphate, 464 
Precipitation, 59 
Preparations, arsenic, 455 

iron, 420. 

potassium, 473. 
Prepared chalk, 482 
Pride of China, 589 
Prunus serotina, 1 61 

Virginiana, 161 
Prussic acid, 306 
Pseudaconine, 235 
Pseudaconitine, 235 
Pseudotropine, 103 
Psychotria emetica, 323 



Pulsatilla, 246 

Pulveres, 58 

Pulvis antimonialis, 252 

aromaticus, 228 

cretae compositus, 484 

ipecacuanha et opii, 89 

morphinse compositus, 90 
Pumpkin, 593 

seed, 593 
Purging cassia, 333 
Purple foxglove, 277 
Pyridine, 520 
Pyrmont spring, 175 
Pyrocatechin, 191 
Pyroxylin, 579 
Pyroxylinum, 579 

Quassia, 140 

amara, 140 
Quassin, 140 
Queen's delight, 384 
Querci-tannic acid, 192 
Quercitrin, 190 
Quercus alba, 192 
Quevenne's iron, 166 
Quillaia, 400 1 
Quince seed, 567 
Quinicine, 151 
Quinidinae sulphas, 159 
Quinidine, 1 50, 152 

commercial, 152 
Quinina, 150 
Quininae bisulphas, 158 

hydrobromas, 158 

hydrochloras, 159 

sulphas, 151, 157 

valerianas, 158 
Quinine, 150 

salts, therapeutical equivalents of, 158 

crude, 159 

carbolate, 159 

citrate 159 

phosphate, 159 

salicylate, 159 

sulphocarbolate, 159 

sulphovinate, 159 
Quinoidin, 159 

Ranunculaceae, 143 
Rawley Springs, 175 
Redbark, 149 

saunders, 584 
Refrigerants, 235, 255 
Resin, 54 
Resina, 407 

Resorcin, 122, 123-510 
Rhatanic red, 19 1 
Rhatany, 191 
Rheotannic acid, 352 
Rheum, 352 

officinale, 352 
Rheumic acid, 354 



608 



INDEX. 



Rhubarb, 352 

Chinese, 352 

European, 352 

Russian, 352 

stick, 352 
Rhus glabra, 195 

toxicodendron, 267 
Rochelle salt, 347 
Rosa centifolia, 195 

gallica, 195 
Rosaceae, 161 
Rosmarinus, 233 
Rubefacients, 213-538 
Rubiaceae, 129, 149 
Rubus, 195 

Canadensis, 195 

trivialis, 195 

villosus, 195 
Rums' pills, 357 

Rules for converting troy weight into 
grams, 67 

apothecaries' measure into cubic cen- 
timeters, 67 
Ruminantia, 136 

Sabina, 421 
Saccharin, 582 
Saccharum, 581 

lactis, 582 

Saturni, 199 
Saffranin, 583 
Saffron, 583 

Saint Morotz Spring, 175 
Salicaceae, 161 
Salicin, 161 
Salicinum, 161 
Salicylic acid, 512 
Saline cathartics, 340 

mineral waters of N. America, 348 
European, 350 

refrigerants, 386 
Salix, 161 

alba, 161 

Helix, 161 
Salol, 515 

Salt of Riverius, 255 
Salvia, 233 

officinalis, 233 
Sanguinaria, 326 
Sanguinarine, 327 
Sanguisuga officinalis, 35 
Santalic acid, 584 
Santalum rubrum, 584 
Santonica, 588 
Santoninum, 588 
Sapindacese, 136 
Sapo vindis, 556 
Saratoga waters, 482 
Sarsaparilla, 380 
Sassafras, 384 

medulla, 566 
Savine, 421 



Scammonium, 367 
Scammony, 367 
Scarifications, 36 
Schooley's mountain springs, 174 
Schwalbach spring, 175 
Scilla, 387-402 
Sclererytherin, 271 
Sclerocrystallin, 271 
Scleroiodin, 271 
Scleromucin, 271 
Sclerotic acid, 274 
Sclerotium, 269 
Scleroxanthin, 271 
Scoparius, 397 
Scruple, 66 
Scutellaria, 128 

laterifolia, 128 

pilosoa, 128 
Secale cereale, 270 
Sedatives, 98-235-387 
Seidlitz powder, 259 
Semi-solids, 58, 64 
Senega, 398-420 
Senega snakeroot, 398 
Senna, 339, 357 

Alexandria, 357 

India, 357 

Mecca, 357 

Tinnevelly, 358 

Tripoli, 357 
Serous membranes application of medicine 

to, 71, 76 
Setons, 34, 36 
Sevum, 575 
Sharon springs, 175 
Silver, preparations of, 206 
Simarubaceae, 140 
Sinapis, 329 

alba, 539 

. ni g ra , 539 
Skin, application of medicines to, 71 
Skullcap, 128 
Slippery elm, 565 

bark, 565 
Sloe, 318 
Smartweed, 423 
Snakeroot, Virginia, 143 
Soap bark, 400 
Soda, 553 

caustic, 553 
Sodii acetas, 386 

arsenias, 463 

benzoas, 509 

bicarbonas, 477 
venalis, 477 

bisulphis, 491 

boras, 494 

bromidum, 300 

carbonas, 476 

exsiccata, 477 

chloras, 470 

hypophosphis, 465 



INDEX. 



609 



Sodii hyposulphis, 491 

iodidum, 451 
nitras, 255 
phosphas, 345 
praeparata, 475 

pyrophosphas, 346 

salicylas, 515 

santoninas, 589 

sulphas, 344 

sulphis, 491 

sulpho-carbolas, 502 
Sodium borate, 494 

nitrite, 314 
Solanaceae, 95, 102, 107, no 
Solanine, no 
Solanum Dulcamara no 
Solids, 58 
Soluble gun-cotton, 579 

tartar, 347 
Solution of ammonium acetate, 256 
Solutions, 60 
Soporifics, 79 
Spa spring, 175 
Spanish fly, 545 
Sparteine, 377, 284 
Spastics, 259 
Special diuretics, 387 
Spermaceti, 575 
Sphacelinic acid, 271 
Spigelia, 585 
Spinants, 78-259 
Spirit of lemon, 259 

nitrous ether, 257 
Spirits, 63 
Spiritus, 63 

aetheris compositus, 138 
nitrosi, 257 

ammonias, 221 

aromaticus, 221, 482 

chloroformi, 118 

cinnamomi, 225 

frumenti, 219 

juniperi, 219 

lavandulae, 232 

Mindereri, 256 

myrciae, 219 

myristicae, 226 

sacchari, 219 

vini Gallici, 219 
Spongio-piline, 65 
Squill, 387, 402 
Squirting cucumber, 371 
St. Ignatius' bean, 266 
St. Louis Spring, 478 
Stabile, 45 
Staphisagria, 248 
Starch, 54, 56, 572 
Stavesacre, 248 
Sternutatories, 72 
Stillingia, 384 
Stimulants, 213 

diffusible, 213 

' 39 



Stimulating diaphoretics, 387 
Storax, 418 
Stramonium, 91 
Strophantus, 283 

hispidus, 283 
Strychnina, 260-265 
Strychninae sulphas, 265 
Strychnine, 260 
Strychnos nux vomica, 260 

Ignatii, 266 
Styrax, 418 
Sublimation, 59 

Subsulphate of mercury, yellow, 442. 
Succinum, 137. 
Sudorifics, 376 
Sugar, 54, 56, 581 
Sugar, barley, 581 
Sugar cane, 581 

grape, 581 

of lead, 199 
milk, 549 

raw, 581 

refined, 581 
Sulphate and ammonium, 203 

potassium, 203 
Sulphides, 492 
Sulphonal, 93 
Sulphur, 336 

crude, 336 

flowers of, 336 

iodide, 452 

praecipitatum, 338 

sublimatum, 336 

washed, 336 

water, American, 338 
European, 339 
Sumbul, 320 
Suppositoria, 64 
Suppositories, 64, 75 
Suppurants, 551 
Swedish Movement cure, 52 
Swamp hellebore, 241 
Sweet flag, 228 

orange peel, 231 

spirit of nitre, 257 
Sydenham's laudanum, 89 
Syrup calcium lactophosphate, 465 

citric acid, 259 
Syrupi, 63 
Syrups, 63 

medicated, 63 
Syrupus, amygdalae, 310 

calcis, 483 

ferri bromidi, 172 
iodidi, 171 

quininae et strychninae phospha- 
tum, 174 

hypophosphitum, 466 
cum ferro, 17-466 

lactucarii, 90 

pruni Virginianae, 162 



610 



INDEX. 



Tabacum, 301 

Table for converting c. c. into f g , 68 

apothecaries' weights and measures 

into gram weights, 69 
of decimal with troy weights, compar- 
ative, 67 
Tablespoon, 68 
Tamarind, 331 
Tamarindus, 331 
Tanacetum, 422 
Tannic acid, 186 
Tansy, 422 
Tar, 406 
Tapotement, 51 
Taraxacum, 395 

Dens leonis, 395 
Tartar emetic, 329-249 
Tartaric acid, 259 
Tartarized antimony, 249 
Tate Epsom Springs, 484 
Tea, 128 
Teaberry, 230 
Teacup, 68 
Teaspoon, 68 
Terebinthina, 402 
Ternstromiaceae, 129 
Tetanocannabine, 108 
Tetterwort, 365 
Thalleioquin, 151 
Thalline, 524 
Thea, 128 

chinensis, 1 28 
Theine, 129 
Theobroma, 130 
Theobromine, 130 
Therapeutics, definition of, 33 

Empirical, 33 

Rational, 33 
Thornapple, ioi 
Thymene, 234 
Thymol, 234-535 
Tinctura asafcetidae, 123 

belladonnae, loo 

calumbae, 143 

cannabis Indicae, 109 

cinchonae, 157 

composita, 157 

ferri acetatis, 173 
chloridi, 170 

gentianae composita, 141 

humuli, 110 

hyoscyami, 104 

ipecacuanhae et opii, 89 

lavandulae composita, '232 

opii, 89 

camphor ata, 89 
deodorata, 89 

saponis viridis, 557 

serpentariae, 144 

stramonii, 102 

Valerianae, 127 

ammoniata 127 



Tincturae, 62 

herbarum recentium, 63 
Tincture of quassia, 141 
Tinctures, 62 

ammoniated, 62 

ethereal, 62 
Tobacco, 301, 229 
Tonics, 78, 139 

mineral, 139, 164 

vegetable, 139 
Topical medicines, 78-485 
Toxicodendric acid, 267 
Tragacantha, 563 
Tragacanthin, 563 
Transfusion of blood, 76 
Trimethylamine, 453 
Triticum, 396 
Triturationes, 58 
Triturations, 58 
Troches, 60 

of ammonium chloride, 468 

chalk, 484 

sodium santoninate, 589 
Trochisci, 60 

ferri, 167 

glycirrhizae et opii, 88 

morphinae et ipecacuanhae, 90 
Tropic acid, 103 
Trdpine, 103 
Troy weight, 66 
Tully's powder, 90 
Turpentine, 405 

Ulcers, application of medicines to, 71, 76 
Ulmus, 565 

Umbel liferae, I2T, 123, 234 
Umbelliferon, 122, 123 
Unguenta, 65 
Unguentum antimonii, 551 
Unguentum aquae rosae, 195 
belladonnas, ioi 
hydrargyri, 430, 432 
ammoniati, 431 
nitratis, 443 
oxidi flavi, 430 
oxidi rubri, 430 
plumbi carbonatis, 202 
stramonii, 102 
sulphuris, 337 

alkalinum, 337 
Urethan, 95 
Urticaceae, 106, 109 
Ustilago, 274 

maydis, 274 
Uva ursi, 414 

Valerian, 127 
Valeriana, 127 

officinalis, 127 
Valerianaceae, 127 
Vallet's ferruginous mass, 167 
Vanilla, 234 



INDEX. 



611 



Vanilla planifolia, 234 

Vanillin, 234 

Vapor bath, 40 

Vapors, 58, 65 

Veins, injections into, 71, 76 

Venesection, 34 

Veratrina, 244 

Veratrum viride, 241 

Vermicide, 584 

Vesicants, 213-544 

Vesication, 41 

Viburnum, 318 

Vichy Waters, 479 

Vina, 63 

Vinegars, 63 

Vinum, 218 

album, 218 

fortius, 218 

antimonii, 252 

aromaticum, 148, 233 

ergotae, 274 

ferri amarum, 173 
citratis, 173 

opii, 89 

rubrum, 218 
Viola tricolor, 332 
Volatile oils, 222 

Wahoo, 367 

Warner's gout cordial, 354 

Water, bath, 40 

cold, 42 

hot, 40 

warm, 42 
Water-pepper, 423 
Weights and measures, 66 
White oak, 192 
Wild cherry, 161 
Wildungen Springs, 484 



Willow, white, 161 
Wine, 218 

aromatic, 218-233 

Madeira, 218 
Wine-measure, 67 

port, 218 

sherry, 218 
Wine-glass, 68 
Wines, 63 
Wintergreen, 415 
Wistar's cough lozenges, 88 
Witch hazel, 1 93 
Woorara, 316 
Wormwood, 1 47 
Wounds, application of medicines to, 71, 76 

Xanthopuccine, 266 

Yellow bark, 149 

jasmine, 314 

mercurial subsulphate, 329 

root, 266 
Young's scheme for doses, 68 

Zinc, iodide, 452 

preparations, 203 
Zinci acetas, 205 

bromidum, 301 

carbonas prsecipitatus, 205 
Zinci chloridum, 205, 555 

iodidum, 205 

oxidum, 204 

venale, 204 

prseparata, 203 

phosphidum, 185 

sulphas, 204, 329 

valerianas, 206 
Zingiber, 227. 



INDEX OF DISEASES AND REMEDIES. 



ABORTION. 

Cotton-Root Bark, to stop hemorrhage, 

276. 
Ergot, to stop the bleeding after, 273. 
Opium Suppository, to relieve the pain, 

88. 
Tampon in vagina when threatened, 

276. 
Viburnum as a sedative, 318. 
ABORTIFACIENTS. 

Cold Water, uterine injection of, 42. 
,. Drastic Cathartics, as Elaterium, 371, 

Jalap, 362, and Scammony, 368. 

Rue, 421. 

Savine, 422. 
ABRASION. 

Adhesive Plaster, 407, and Collodion, 

580, as protectives. 
Liquor Gutta Perchae as a protective 

coating, 580. 
Petrolatum and Carbolic Acid, 579. 
ABSCESS. 

Aspirator, to evacuate, 39. 
Belladonna topically to relieve pain, 99. 
Boric acid as antiseptic dressing, 493. 
Carbolic acid injection, 500; to relieve 

pain before evacuation, 501. 
Caustic Potassa, to avert inflammation, 

553- 
Cocaine, as local anaesthetic, 135. 
^ Corrosive Sublimate by injection, 489. 
Iodine tincture topically to abort, 

447- 

Lead Water as sedative, 2QO. 

Leeches, to prevent formation of, 36. 

Local anaesthesia, 120. 

Malt-liquors for chronic, 219. 

Opium topically, 88. 

Peppermint oil as local antiseptic, 232. 

Phytolacca topically to allay inflam- 
mation, 248. 

Potassium Permanganate to wash cav- 
ity of, 487. 

Poultices, 559. 

Precipitated Calcium Phosphate, 465. 

Sulphides to check suppuration, 492. 

612 



ACIDITY. 

Alkalies, 472. 

Alkaline mineral Waters — European, 

479- 

Alkaline mineral waters — North Amer- 
ican, 478. 

Ammonium preparations, 220, 482. 

Calcareous waters — European, 484. 

Calcareous waters — North American, 
484. 

Calcium preparations, 482. 

Lactic Acid, 182. 

Lithian mineral waters, 481. 

Lithium preparations, 480. 

Potassium preparations, 253, 473. 

Sodium preparations, 475. 
ACNE. 
y Alkaline lotion if skin is greasy, 474. 

Arsenic, 461. 

Borax lotion, 494. 

Citrine ointment, 443. 

Carbolic acid to pustules, 501. 

Fowler's solution, 462. 

Icthyol topically, 537. 

Nitric acid to pustules, 179. 

Quillaia, 401. 

Scarification, 36. 

Sulphur iodide topically, 452. 

Sulphur ointment, 337. 

Sulphur mineral waters, European, 339. 

Sulphur mineral waters, North Ameri- 
can, 338. 
ADENITIS (see also Abscess). 

Belladonna as local anodyne, 101. 

Cod-liver oil, 454. 

Iodine tincture topically, 457. 

Leeches, 36. 

Poultices, 559, 565. 
ADYNAMIA (see Asthenia). 
AFTER-PAINS. 

Camphor as anodyne, 125. 

Cimicifuga, 285. 

Ergot to induce uterine contraction and 
expel clots, 273. 

Morphia and Atropia hypodermically, 
87. 



INDEX OF DISEASES AND REMEDIES. 



613 



AFTER-PAINS (continued). 

Quinine, 156. 

Viburnum, 318. 
ALBUMINURIA (see Brights Dis- 
ease). 

Basham's Mixture, 170. 

Chalybeate mineral waters, European, 

175- 

Chalybeate mineral waters, North 
American, 174. 

Gallic acid, 188. 

Milk diet. 

Tannic acid, 188. 
ALCOHOLISM. 

Ammonia, aromatic spirits of, as sub- 
stitute for alcohol, 222. 

Capsicum as stomachic and substitute 
for alcohol, 224. 

Chloral as hypnotic, 295. 

Hydrobromic acid dilute as sedative, 
301. 

Mindererus, spirit of, 256. 

Morphia as hypnotic, 85. 

Potassium bromide to quiet excite- 
ment, 298. 

Strychnine hypodermically, 265. 

Sulpnonal, 94. 
ALOPECIA. 

Alcohol and ammonia water, 218. 

Arsenic, 461. 

Cantharidal collodion, 550. 

Sapo viridis in alcohol, shampoo with, 
556, — afterward apply carbolic acid 
(501) in glycerin and cologne. 

Iodized collodion, 580. 

Pilocarpia, 380. 
AMAUROSIS. 

Electricity, 50. 

Nux Vomica, 264. 

Potassium iodide if syphilitic, 450. 

Mercury, if syphilitic, 428. 

Strychnine hypodermicallv, 264-5. 
AMENORRHCEA. 

Aconite occasionally useful, 240. 

Aloe, 356. 

Aloe and iron pills, 357. 

Ammonium chloride, 467. 

Apiol as ovarian stimulant, 423. , 

Borax, 494. 

Cantharides, 397. 

Guaiac, 382. 

Mistura ferri carbonatis, 168. 

Mustard and hot water foot-bath, 

S4i. 

Polygonum hydropiperoides, 423. 
Potassium permanganate, 486. 
Rue, oil of, 422. 
Rufus' pills, 357. 
Sanguinaria, occasionally, 327. 
Savine, 421. 

Sitz-bath, hot, a few days before the 
expected period, 40. 



ANEMIA. 

Alcohol, 218. 

Ammonia water as stimulant, 221. 

Arsenic, iron and quinine, 461. 

Broths. 

Chalybeate natural waters, European, 

175- 

Chalybeate natural waters, North 
American, 174. 

Cream. 

Ferri sulphas exsiccatus, 168. 

Ferric chloride, tincture of, 170. 

Ferrum reductum, 166. 

Iron — preparations, 165. 

Fowler's Solution, 463. 

Malt-liquors, 219. 

Manganese preparations, 176. 

Pancreatin, 163. 

Pepsin, 162. 

Phosphorus, 185. 

Precipitated lime phosphate, 465. 

Red- Wines, 218. 

Saratoga iron-waters, 348. 
ANASARCA (see Ascites and Drop- 
sy). 
ANEURISM. 

Aconite to control circulation, 240. 

Aliment, low diet. 

Electrolysis to form clot, 50. 

Ergot, 273. 

Lead preparations, as sedatives and 
astringents, 199. 

Potassium iodide, 450-1. 

Rest, very important. 

Veratrum Viride to moderate vascular 
excitement, 244. 
ANGINA PECTORIS: Attack. 

Arsenic, 461. 

Ferric chloride, tincture of, 170. 

Galvanism, 49. 

Phosphorus, 185. 
ANGINA PECTORIS: Seizure. 

Amyl nitrite, inhaled from crushed 
capsule, 312. 

Ether, as antispasmodic, 112. 

Lobelia, 306. 

Morphia, hypodermically to relieve 
pain, 89. 

Nitroglycerin, 312. 

Pyridine, 521. 

Sodium nitrite, 314. 
ANIDROSIS. 

Bath, hot, 40. 

Bath, steam, 41. 

Frictions, 36. 

Pilocarpia, 380. 
ANOREXIA. 

Alcohol, 217. 

Calumba, 142. 

Cascarilla, 149. 

Chirata, 142. 

Cinchona and Quinine, 156. 



614 



INDEX OF DISEASES AND REMEDIES. 



ANOREXIA (continued). 

Eupatorium, 147. 

Ferruginous preparations, 165-174. 

Gentian, 141. 

Indian hemp, 108. 

Magnolia, 148. 

Mineral acids, 177. 

Nux Vomica, 265. 

Quassia, 141. 

Serpentaria, 146. 
ANTHRAX (see Carbuncle). 
ANTIDOTES (see general index for 

each drug). 
APHONIA. 

Electricity (see Hoarseness). 
APOPLEXY. 

Aconite to control excited circulation, 
238. 

Croton Oil to relieve cerebral conges- 
tion, 373. 

Faradization, 49. 

Purgatives, 330, as Jalap, 360, and 
Scammony, 367. 

Sinapisms to neck and extremities, 541. 

Stimulants, as Alcohol, 217, Ammonia, 
221, and Ether, 112, to sustain 
heart in thrombosis and embolism. 
APTHiE. 

Borax mouth-wash, 494. 

Boric acid, 493. 

Catechu, 190. 

Myrrh, 417. 

Potassium chlorate, very useful, 470. 

Sodium sulphite, 491. 

Sulpho carbolates, 502. 

Sumach, 195. 
ASCARIDES (see Worms). 
ASCITES. 

Aspiration, 39. 

Croton oil, 373. 

Digitalis, 281. 

Drastic cathartics, as Jalap, etc., 360-2. 

Elaterium, 371. 

Ferric chloride, tincture of, 170. 

Podophyllum, 363. 

Scammony, 368. 
ASPHYXIA. 

Alcohol, 217. 

Ammonia, internally, and by inhala- 
tion, 221. 

Bath, hot, 40. 

Cold affusions, 42. 

Electro-magnetism, 50. 

Rubefacients, 539. 
ASTHENIA. 

Alcohol, 217. 

Cod-liver oil, 454. 

Diet, nourishing, of first importance. 

Ferruginous preparations, 166. 

Ferri carbonas saccharatus, 167. 

Gentian, 141. 



ASTHENIA (continued). 

Malt-liquors, 219. 

Pancreatin, 163. 

Quassia, 141. 

Quinine, 156. 

Wines, 218. 
ASTHMA. 

Amyl nitrite, 312. 

Antipyrine, 527. 

Atropine, 99. 

Diet of liquid food to avoid distending 
alimentary canal. 

Ether, 112. 

Etherization, only if severe, 114. 

Grindelia, 320. 

Hydrocyanic acid, 309. 

Hyoscine hydrochlorate, 105. 

Morphine hypodermically to relieve 
paroxysm, 87. 

Nitrites, 314. 

Nitroglycerin, 312. 

Nitrous papers, 255. 

Potassium iodide between paroxysms, 

45o. 
Pyridine by inhalation, 521. 
Quinine to abort paroxysm, 156. 
Sodium arseniate cigarettes, 464. 
• Stramonium smoke, 102. 
BALANITIS. 

Acupuncture for oedema of prepuce, 36. 
Black wash, 435. 
Carbolic acid lotion, 501. 
Dermatol, 537. 

Iodoform to excoriations, 530. 
BALDNESS (see Alopecia). 
BASEDOW'S DISEASE (see Ex- 
ophthalmic goitre). 
BED-SORES. 

Alcohol to harden parts previously 

washed with soap and water, 218. 
Alum lotion, 212. 
Collodion for abrasions, 580. 
Condy's Fluid to keep parts clean, 487. 
Iodoform, 530. 

Liquor gutta perchse as protective, 580. 
Poultices to remove sloughs, 559. 
Soap plaster, 201. 
Stramonium topically, 102. 
Zinc oxide to keep dry, 204. 
Zinc oxide ointment to keep supple, 
204. 
BELL'S PALSY (see Facial paraly- 
sis). 
BILIARY CALCULI (see Calculi). 
BILIOUSNESS (meaning anorexia, 
furred tongue, nausea, head- 
ache and constipation). 
Diet, light, and easily assimilated. 
Blue pill, 431. 
Jalap, 362. 
Magnesia, 342. 



TNDEX OF DISEASES AND REMEDIES. 



615 



BILIOUSNESS (continued). 
Saline cathartics, 340 et al. 
Seidlitz powder, 347. 
BITES OF INSECTS (see Virus of 

venomous animals). 
BLADDER, IRRITABILITY OF. 
Ammonium benzoate, as vesical anti- 
septic and to neutralize urine, 510. 
Anodyne enemata, 376. 
Antacids, 473, 484. 
Belladonna suppository, 99. 
Benzoic acid, as vesical antiseptic, 509. 
Cocaine-gelatin bougie, 134. 
Copaiba, 409. 
Couch grass to allay urinary irritation, 

396. 
Matico, 413. 
Naphthaline, 518, and Salol, 517, to 

prevent decomposition of urine. 
Pareira with Juniper, 413 (see foot- 
note). 
BLEPHARITIS. 

Boracic ointment as mild antiseptic, 

494- 

Sodium bicarbonate gr. v to tepid 
water f J;j to remove crusts, 478. 

Yellow mercuric oxide ointment when 
removed, 434. 
BLISTERED SURFACES (see also 
Excoriations). 

Belladonna topically, 99. 

Cold cream, 195. 

Goulard's cerate, 200. 

Petrolatum, 579. 

Resine-cerate, 407. 
BOILS. 

Arsenic, in chronic cases, 461. 

Belladonna, topically to relieve pain, 
99. 

Emplastrum opii, 89. 

Galbanum plaster, 123. 

Iodine, topically to prevent suppura- 
tion, 447. 

Lead water, 200, 

Opium topically, 88. 

Poultices, if suppuration be unavoid- 
able, 559. 

Sulphides to check suppuration, 492. 

Sulphurous waters, 338-39 "I in chronic 

Vichy water, 475 J cases. 

BREATH, FETOR OF. 
_ Borax mouth-wash, 494. 

Carbolic acid, 501. 

Dobell's solution, 74. 

Liquor caicis, 483. 

Myrrh and Carbolic wash, 417. 
BRIGHT'S DISEASE, ACUTE. 

Bedford spring water, 479. 

Cups, wet or dry, in 1st stage, 35. 

Diet, milk; avoid eggs; farinaceous 
suitable. 

Digitalis, a non-irritating diuretic, 281. 



BRIGHT'S DISEASE, ACUTE 

(continued). 

Poland spring water, 479. 

Potassium bitartrate as hydragogue and 
diuretic, 347. 

Potassium bromide to relieve convul- 
sions (see Uremia), 299. 

Saline cathartics to remove dropsy, 
329-342, et a!. 

Saline cathartics concentrated, to re- 
move dropsy, 343. 
BRIGHT'S DISEASE, CHRONIC. 

Auric and sodic chloride, 444. 

Basham's Mixture as diuretic, 170. 

Baths, hot vapor, if renal action be 
suspended, 41. 

Bedford spring water, 479. 

Chloral for convulsions, 295. 

Convulsions of, (see Uremia). 

Cupping, to relieve convulsions, 36. 

Diet (see acute form). 

Digitalis as diuretic, 281. 

{Aspiration for deep, 39. 
Scarifications for superfi- 
cial, 36. 

Elaterium as hydragogue, 371. 

Gallic acid to lessen albumen, 1S8. 

Jalap as hydragogue, 362. 

Juniper and Potassium bitartrate if 
active diuresis be necessary, 397. 

Pilocarpia as diaphoretic, 379. 

Poland spring water, 479. 

Saline cathartics, 342-7. 

Scammony as hydragogue, 368. 

Scoparius as diuretic, 397. 

Tannic acid to lessen albumen, 188. 
BRONCHITIS, ACUTE. 

Aconite to be given early, 239. 

Ammonium muriate, 467. 

Apomorphia, 328. 

Asafcetida plaster, 123. 

Brown mixture, 569. 

Croton oil topically, 373. 

Dover's powder administered early, 89. 

Eucalyptus oil, 145. 

Frictions with liniments as Oil of tur- 
pentine, 405 and 36. 

Garlic as expectorant, 402. 

Hive-syrup, 389. 

Ipecac, 324-5. 

Mustard and hot water to feet, 541. 

Opium or Morphia to relieve cough, 87. 

Paregoric, 89. 

Potassium bromide to relieve night- 
cough, 298. 

Poultice to chest in early stage, 559. 

Senega, 399. 

Sinapism to chest, 541. 

Squill, 389. 

Tar, 406. 
BRONCHITIS, CHRONIC. 

Alum atomization, 212. 



616 



INDEX OF DISEASES AND REMEDIES. 



BRONCHITIS, CHRONIC (cont'd). 

Ammoniac, 123. 

Ammonium carbonate, 222. 

Ammonium iodide, 451. 

Apomorphia, 328. 

Benzoin,. 41 8. 

Burgundy pitch plaster, 543. 

Carbolic acid spray, 500. 

Cimicifuga, 287. 

Copaiba, occasionally, 409. 

Creasote, 503. 

Croton oil as counter-irritant, 551. 
*Ems water, 480. 

Eucalyptus, 145. 

Grindelia, 320. 

Iodine tincture to chest, 447. 

Iodine vapor by inhalation, 447. 

Nux vomica, 264. 

Senega, 399. 

Sinapism to chest, 541. 

Squill, 389. 

Sumbul, 320. 

Tar, 406. 

Turpentine internally, 404. 

Turpentine stupes, 405. 

Warming plaster, 543. 
BRONCHITIS, CAPILLARY. 

Alcohol as stimulant, 217. 

Ammonium carbonate, 222. 

Ammonium iodide, 451. 

Apomorphia, 328. 

Ipecac as expectorant and emetic, 

324- 
BRONCHOCELE (see Goitre). 
BRUISES (see also Wounds). 

Arnica topically, 247. 
BUBO. 

Aspirator to evacuate, 39. 

Calcium sulphide to check suppura- 
tion, 492. 

Carbolic acid dressing when opened, 
501. 

Dermatol as dressing, 537. 

Iodine tincture topically, 447. 

Iodoform as dressing, 531. 

Iodol, topically, 534. 

Leeches, early, 36. 

Peppermint oil as dressing, 232. 

Poultices when suppuration is unavoid- 
able, 559. 

Pressure to cause subsidence. 

Rest. 
BURNS (see Scalds). 

Boric acid, 493. 

Carbolic acid as dressing, 501. 

Carron oil, 483. 

Cotton, 276. 

Glycerin-dressing, 578. 

Goulard's cerate, 200. 

Iodoform, 530. 

Resin-cerate, 407. 

Salol and olive-oil, 517. 



BURNS (continued). 

Sodium bicarbonate sprinkled over, 
478. 
BURSA, DISEASES OF. 

Aspiration, 39. 

Belladonna ointment, 101. 

Carbolic acid injection, 500. 

Cocaine, hypodermically, before eva- 
cuation, 135. 

Elastic bandage to promote absorp- 
tion, 36. 

Iodine, tincture, by injection, to oblit- 
erate sac, 447. 

Poultices, 558-9. 
CACHEXIA. 

Cod-liver oil, 454. 

Fresh air with appropriate exercise. 

Iron-preparations, 166. 

Manganese preparations, 176. 

Massage, 52. 

Mercury, if syphilitic, 428. 

Nutritious aliment. 

Potassium iodide, if syphilitic, 450. 
CALCULI, BILIARY. 

Aliment ; avoid starchy and farina- 
ceous foods. 

Alkaline mineral waters between at- 
tacks, as Bedford Spring, Fachin- 
gen and Vichy, 479. 

Baths, hot hip, to relieve pain, 40. 

Ether, as solvent, 112. 

Etherization, if pain be severe, 114. 

Morphia, hypodermically, to relieve 
pain, 86. 

Purgation, 330. 

Sodium phosphate, to promote solu- 
tion, 345. 
CALCULI, RENAL. 

Aliment, restricted as to quantity. 

Baths, hot hip, to relieve pain, 40. 

Bedford Spring water, 479. 

Carlsbad water, 351. 

Contrexville water, 484. 

Ems water, 479. 

Ether as solvent, 112. 

Etherization to relieve pain, 1 14. 

Fachingen water, 479. 

Friedrickshall water, 351. 

Hydratis to promote discharge of, 
267. 

Marienbad water, 351. 

Morphia, hypodermically, to relieve 
pain, 86. 

Poland Spring water, 479. 

Polygonum, hydropiperoides, to ex- 
pel small calculi, 423. 

Potassium acetate, 386. ) To neutralize 

Potassium citrate, 256. / urine. 

Vichy water, 479. 

Wildungen water, 484. 
CANCER. 

Aristol, topically, 533. 



INDEX OF DISEASES AND REMEDIES. 



61' 



CANCER (continued). 

Arsenic, topically, 462, 554. 
Bromine as escharotic, 555. 
Cocaine, to allay pain, 134. 

Escharotics, 551. 

Rectum, of, Anodyne enemata, 376. 

Scirrhus of pylorus, Nutrient enemata, 
376. 
CANCRUM ORIS. 

Lunar caustic, 552. 

Nitric acid as caustic, ijg. 

Poultices to cheek, 559. 
CARBUNCLE. 

Belladonna, topically, 99. 

Carbolic acid dressing, 501. 

Caustic potassa, to arrest sloughing of, 
552. 

Caustic soda, 553. 

Escharotics, 551. 

Iodine tincture, topically, 447. 

Opium, topically, 88. 

Potassium permanganate, 487. 

Poultices, 559. 

Sulphides, to check suppuration, 492. 
CATARACT. 

Atropine, 100 ; Duboisia, 105; and 

Homatropine, 100, to improve vision, 

but surgical interference or lenses 

is the appropriate treatment. 

CATARRH, ACUTE NASAL (Cold 

in head). 

Aconite, 339. 

Camphor, 126. 

Cocaine spray, to relieve occlusion, 

!35- 
Cubeb-smoke, 411. 
Dobell's solution to cleanse nostrils, 

74- 
Dover's powder, early, 89. 
Iodine vapor, 447. 
Menthol in petrolatum, 579. 
Mustard and hot water foot-bath, 541. 
Silver nitrate, topically, 208. 
CATARRH, CHRONIC NASAL. 
Aristol, topically, 533. 
Bromine by inhalation, 555. 
Carbolic acid spray, 500. 
Cocaine spray to relieve occlusion, 

135- 
Cubeb-smoke, 411. 
Dobell's solution to cleanse nostrils, 

74- 
Galvanic cautery, 51. 
Glycerin, to soften scabs, 577. 
Iodine vapor, 447. 
Mackenzie's alkaline wash, 478. 
Menthol in petrolatum, 579. 
Petrolatum to soften scabs, 579. 
Silver nitrate topically, 208. 
Tannin, 187. 
Zinc sulphate, 204. 
CEPHALALGIA (see Headache). 



CEREBRAL ANEMIA. 

Ammonia by inhalation, 221. 

Faradization, 49. 

Ferric chloride, tincture of, 170. 

Recumbent posture. 

Stimulation, 271. 
CEREBRAL HYPEREMIA. 

Aconite to control circulation, 240. 

Cold compresses to head, 42. 

Croton oil, 373. ^ 

Elaterium, 371. las purgatives. 

Epsom Salt, 343. J 

Ice cap, 42. 

Jalap as hydragogue, 362. 

Potassium bromide, to lessen cerebral 
blood supply, 298. 

Raising head. 

Scammony as hydragogue, 368. 
CEREBRO-SPINAL MENINGI- 
TIS. 

Aconite to diminish frequency and 
force of cardiac action, 240. 

Alcohol to arouse from collapse and 
to antagonize .adynamia, 217. 

Blisters to neck and back to arouse, 545. 

Magnesium sulphate to relieve cere- 
bral hyperemia, 343. 

Opium to relieve pain, 87. 

Potassium bromide (second stage) to 
allay excitement, 298. 

Potassium iodide to promote absorp- 
tion, 450. 
CHAFING. 

Lycopodium, 570. 

Sapo viridis, 556. 

Starch, Soapstone and Salicylic Acid, 

573- 
Tepid water and Potassium Nitrate, 
40. 
CHANCRE AND CHANCROID. 

Black wash, 435. 

Bromine as caustic, 553. 

Carbolic acid lotion, 501. 

Caustic potassa, 552. 

Caustic soda, 553. 

Dermatol, 537. 

Escharotics, 551. 

Iodoform, 530. 

Iodol, 534. 

Liquor hydrargyri nitratis, 444, 

555- 
London paste, 553. 
Naphthol, 520. 
Nitric acid, 179. 
Potassa cum calce, 553. 
Potassium bichromate, 471. 
Yellow wash, 435. 
CHAPS. 

Cold cream, 195. 
Glycerin, 577. 
Liquor gutta perchae, 580. 
Zinc oxide ointment, 204. 



618 



INDEX OF DISEASES AND REMEDIES. 



CHILBLAIN. 

Belladonna or Opium ointment to re- 
lieve pain and itching, 101. 

Carbolic ointment, 501. 

Chloroform liniment, 1 18. 

Cold affusions with friction, 42. 

Icthyol, 537. 

Iodine tincture, if tissues are unbroken, 
448. 

Soap liniment, 126. 

Turpentine liniment, 405. 

Zinc oxide ointment after puncture of 
blebs, 204. 
CHLOROSIS. 

Arsenic with iron and quinine, 461. 

Chalybeate natural waters, 174-5. 

Diet, nourishing. 

Ferri praeparata, 165. 

Ferrum carbonate mixture, 168. 

Ferrum lactate, 173. 

Ferrum reductum, 166. 

Fowler's solution, 463. 

Manganese preparations, 476. 

Quassia, 141. 
CHOLERA, ASIATIC. 

Arrowroot and milk diet. 

Baths (in 2nd stage), at loo° F., 1-3 
times daily, for 20 minutes, followed 
by drying and envelopement in hot 
flannels and taking warm aromatic 
drinks. Very good results claimed 
for this plan. 

Camphor 125, Opium 86, and Lead 
acetate 199 of each gr. j, every 
Yz-2 hours to check initial diarrhoea 

Cantani's plan or enteroclysis; viz., in- 
testinal irrigation above the ileocce- 
cal valve with tannin, ^ %~% ) 
acacia. |jj; laudanum, gtt. xx ; 
water (sterilized by boiling) at 102 
F., Oiij-iv. The injections should 
be given early, and about 2 to 6 
daily. In the algid stage the hypo- 
dermic injection of about Oj of a 
solution of sodium chloride (4 per 
cent.) and carbonate (3 per cent.) 
into the abdomen below the costal 
arches to supply salines and water 
lost in the discharges. 

Cracked ice for thirst and vomiting, 43. 

Mustard to abdomen to check vomit- 
ing, 541- 

Sodium phosphate, 345. 
CHOLERA, INFANTUM. 

Castor-oil, 335. 

Chlorodyne, 118. 

Cracked ice, 43. 

Hematoxylon, 192. 

Paregoric, 89. 
CHOLERA, MORBUS (see also C. 
Asiatic). 

Castor-oil, 335. 



CHOLERA, MORBUS (continued). 
Chlorodyne, 118. 
Morphia and Atropia hypodermically, 

87. 

Mustard to abdomen, 541. 
CHORDEE. 

Belladonna and Opium suppository, 98. 

Camphor, 125. 

Hops, no. 

Ice-water in bottle to perineum at 
night, 43. 

Morphia hypodermically, the best 
remedy, 87. 

Potassium bromide, 299. 
CHOREA. 

Ammonium valerianate, 127. 

Arsenic, 461. 

Cerium oxalate, 211. 

Chloral, 295. 

Cimicifuga, 287. 

Cold affusions, 42. 

Conium as motor-depressant, 289. 

Etherization to control spasms, 114. 

Ether spray to spine, 42. 

Exalgine, 508. 

Ferrous bromide, syrup of, 172. 

Hydrobromic acid dilute, 30 f. 

Hyoscyamine sulphate, 104. 

Indian hemp, 108. 

Iron, if anemic, 166. 

Musk, 137. 

Physostigma as motor-depressant, 292. 

Woorara as motor-depressant, 318. 

Zinc sulphate, 204. 
CIRRHOSIS (see Liver, affections of). 
! COLD IN HEAD (see Catarrh, acute 
nasal). 
COLIC, INTESTINAL. 

Chloroform as antispasmodic, 117. 

Ether as antispasmodic, 1 12. 

Ginger, 228. 

Morphia hypodermically, 86. 

Mustard to abdomen, 541. 

Purgatives ns castor-oil in 1st stage, 335. 
COLICA PICTONUM. 

Belladonna as antispasmodic, 99. 

Epsom salt, 343. 

Opium to relieve pain, 86. 

Potassium iodide as eliminator, 450. 

Prophylaxis most important. 

Sulphur, natural baths, 338-9-40. 
COLLAPSE. 

Alcohol, 2 1 8. 

Ammonia water, 221. 

Brandy or Whiskey, 219. 

Cocaine internally or hypodermically, 
to sustain heart, 136. 

Hot water-bottles to extremities, 40. 
COMA. 

Blisters, 545-8. 

Cold affusions, 42. 

Electro-magnetism, 50. 



INDEX OF DISEASES AND REMEDIES. 



610 



CONDYLOMATA. 

Black wash, 435. 

Carbolic acid, 501. 

Chromic acid, occasionally, 554. 

Copper sulphate, 203. 556. 

Liquor hydrargyri nitratis dilutus, 

444-. 
Resorcin, 511. 
CONJUNCTIVITIS. 

Alum, 212. \ 

Borax, 494. I Collyria. 

Boric acid, 494. J 

Cold applications for photophobia, 42. 

Iodoform, 531. 

Iodol, 534. 

Resorcin, 511. 

Salicylic acid, 515. 

Scarifications, 36. 

Silver nitrate, 208. \ 

Tannic acid, 187. \ Collyria. 

Zinc sulphate, 204. J 
CONSTIPATION. 

Aloe alone or with Belladonna, 356. 

Belladonna, 99. 

Blue mass, 374, 431. 

Calomel, 374, 436. 

Carlsbad water, 351. 

Cascara, 360. 

Cassia fistula, ^^^. 

Castor-oil, 335. 

Colocynth, if obstinate, 369. 

Compound cathartic pills, 370. >» 

Croton oil, 373. 

Electricity, 48. 

Enemata, purgative, 375. 

Friedrickshall water, 351. 

Gamboge, if obstinate, 370. 

Glycerin enema, 578. 

Homburg water, 350. 

Hunyadi Janos, 351. 

Hyoscyamus, 104. 

Juglans, 354. 

Leamington water, 351. 

Liquor magnesii citratis, 344. 

Magnesia, 342. 

Manna, 332. 

Marienbad water, 351. 

Molasses, 482. 

Nux vomica with aloe, 264. 

Podophyllum, 363. 

Saratoga water, 348. 

Senna, 358. 

Sodium phosphate, 345. 

Tamarind, 331. 

Viola tricolor, 332. 

Water, 561. 
CONVALESCENCE. 

Alcohol, 217. 

Calumba, 142. 

Chirata, 143. 

Cinchona and its alkaloids, 156. 

Diet, easily assimilated and nourishing. 



CONVALESCENCE (continued). 

Gentian, 141. 

Malt-liquors, 219. 

Quassia, 141. 

Wines, 218. 
CONVULSIONS. 

Bath, warm, 40. 

Camphor monobromata, 126. 

Chloral, 295. 

Emetic, if stomach be overloaded, 322. 

Etherization, only if severe, 114. 

Ice-bag, spina], 42. 

Potassium bromide, very useful, 299. 
CONVULSIONS, UREMIC (see 

Uremia). 
CORNEA, OPACITY OF. 

Calomel topically, 437. 

Cod-oil topically, 415. 

Iodol topically, 534. 

Yellow mercuric oxide ointment, topi- 
cally, 434- 
CORYZA (see Catarrh, nasal acute). 
COUGH. 

Alum solution to throat 212. 

Brown Mixture, 569. 

Codeia, 90. 

Croton chloral hydrate, 295. 

Hydrocyanic acid dilute, 309. 

Ipecac, if much difficulty in raising 
phlegm, 324. 

Liquorice lozenge, for pharyngeal, 566. 

Marrubiura, 233. 

Potassium bromide, in spasmodic 
cough, 298. 

Potassium chlorate lozenge, 470. 

Silver nitrate solution to pharynx, 208. 

Tannin gargle, 187. 

Tolu balsam, by inhalation, 420. 

Wild Cherry, 162. 

Wistar's cough lozenge, 88. 
CROUP. 

Alum emetic, 212. 

Bath, warm, 40. 

Hive syrup, 399. 

Hydrargyri subsulphas flavus, as emetic, 

443- 
Ipecac emetic, 324. 
Lactic acid, as solvent, 182. 
Liquor calcis, atomized, 483. 
Senega, 399. 

Sinapism to sternum, 541. 
CYSTITIS, ACUTE.. 

Abstinence from alcoholic stimulants, 

214. 
Althaea, 566. 
Anodyne enemata , 376. 
Baths, hot hip, 40. 
Belladonna, as vesical anodyne, 100. 
Couchgrass decoction, 396. 
Demulcents, 558. 
Diet: milk and farinaceous foods. 



620 



INDEX OF DISEASES AND REMEDIES. 



CYSTITIS, ACUTE (continued). 
Hyoscyamus, 104. 
Liquor potassae, to keep urine neutral, 

474- 

Naphthaline, to prevent urinary decom- 
position, 518. 

Opiurmand Belladonna suppository, 88. 

Salol, to prevent urinary decomposi- 
tion, 517. 

Ulmus, 556. 
CYSTITIS, CHRONIC. 

Anodyne enemata, 376. 

Benzoic acid, as vesical antiseptic, 509. 

Benzoin, 418. 

Boric acid, to prevent ammoniacal 
urine, 493. 

Buchu, 414. 

Capon Spring water, 479. 

Contrexville water, 484. 

Ems water, 480. 

Eucalyptus, 145. 

Fachingen water, 480. 

Hydrastis, 267. 

Liquor potassae or sodae, to lessen acid- 
ity, 474-6- 

Pareira, 413. 

Regular catheterization. 

Saccharin, 583. 

Triticum repens decoction, 396. 

Uva ursi, 415. 

Vesical injections of acid carbolic, 
Tl\ij, aquae, f^jv; or borax, gr 
viij-xx, with glycerin, fsjij, and 
water, f\^jv; or nitric acid, dilute 
T)\v-x to water f^jv; or plumbi 
acetas gr. ]/ z to water ^jv; or 
simple tepid water. 

Vichy water, 479. 
4 Wildungen water, 484. 
DELIRIUM TREMENS. 

Alcohol in small doses to " taper off 
with," 217. 

Camphor monobromata, 127. 

Chloral, 295. 

Digitalis in large doses, 281. 

Gelsemium, 316. 

Hypnone, 94. 

Morphia, hypodermically, the best 
remedy, 85. 

Paraldehyd, 92. 

Potassium bromide, to remove delu- 
sions and procure sleep, 298. 

Sulphonal, 94. 
DENGUE. 

Belladonna tincture said to give relief, 

Quinine as antiperiodic and tonic, 156. 
Salicylic acid for rheumatic pains, 

5H- 
DIABETES INSIPIDUS. 

Diet : absence of fluids. 

Ergot, one of the best remedies, 273. 



DIABETES INSIPIDUS (contin'd). 

Pilocarpus, 379. 

Valerian, decreases urinary flow, 127. 
DIABETES MELLITUS. 

Alkalies, 473-84. 

Ammonium phosphate, 468. 

Carbolic acid, 500. 

Carlsbad water, 351. 

Codeia, 90. 

Diet of first importance : avoid all 
sugary and farinaceous articles, as 
sugar, wheat bread, rice and pota- 
toes; substitute for them saccharin, 
583, gluten, almond and bran bread, 
and green vegetables ; meats may be 
eaten freely. Wines, liquors and 
beers prohibited. 

Fachingen water, 479. . 

Fowler's solution, 463. 

Friedrickshall water, 35 1. 

Iodoform, 530. 

Opium, 88. 

Thymol, 335. 

Vichy water, 479. 
DIARRHOEA, ACUTE. 

Acacia, 567. 

Bismuth in large doses, 209. 

Camphor, 125. 

Calomel, 437. 

Castor-oil, to empty intestines, 335. 

Catechu, 190. 

Cetraria decoction, 571. 

Chalk mixture, 484. 

Charcoal, 538. 

Chlorodyne, 118. 

Chloroform, to relieve colic, 117. 

Demulcents, 538. 

Diet: milk, arrowroot, boiled rice, 
eggs, sago, tapioca, and clear soup. 

Dover's powder, 89. 

Gallic acid, 188. 

Hope's camphor mixture, very useful, 
126. 

Indian hemp, 108. 

Lime preparations, 482. 

Mineral astringents if obstinate, 194- 

213. 

Naphthaline, to check intestinal de- 
composition, 518. 

Opium, 86. 

Paregoric, 89. 

Rhubarb, 3 1 4. 

Rubus, 195. 
DIARRHOEA, CHRONIC. 

Alum, 211. 

Alum- waters, 212-13. 

Astringent enemata, 375. 

Bark, white oak, 193. 

Bismuth subnitrate in large doses, 
209. 

Brandy, 219. 

Carbolic acid, 500. 



INDEX OF DISEASES AND REMEDIES. 



621 



DIARRHOEA, CHRONIC (contin'd). 

Catechu, 190. 

Cetraria, 571. 

Chondrus, 572. 

Copper sulphate, 203. 

Corrosive sublimate, 439. 

Creasote, 503. 

Diet (see acute form). 

Ferri et ammonii sulphas, 174. 

Hematoxylon, 192. 

Kino, 191. 

Krameria, 191. 

Lead preparations, 199. 

Nutgall, 189. 

Salol, to prevent intestinal decomposi- 
tion, 5 r7- 

Silver nitrate, 207. 

Tannin, 187. 

Wines, Port and Red, 218. 

Zinc sulphate, 204. 
DIPHTHERIA. 

Alcohol, 217. 

Alum topically, 212. 

Carbolic acid internally and exter- 
nally, 500. 

Hydrochloric acid as caustic, 180. 

Lactic acid as solvent; 182. 

Liquor calcis atomized, 483. 

Papaya, 164. 

Potassium chlorate internally and as 
gargle, 470. 

Potassium permanganate internally 
and as gargle, 487. 

Salicylic acid internally and as gar- 
gle, 5I4-I5- 

Sodium benzoate, 509. 

Thymol as gargle, 535. 
DROPSY. 

Apocynum cannabinum, 395. 

Aspiration, 39. 

Bandages, 36. 

Basham's mixture, 170. 

Bryony, 363. 

Caffeine, 130. 

Calomel, 389. 

Chimaphila (in cardiac), 415. 

Cimicifuga, 287. 

Digitalis (in cardiac), 281. 

Elaterium, 371. 

Ether, spirit of nitrous, 257. 

Gamboge, 370. 

Jalap, 362. 

Juniper seeds and Potassium bitartrate 
— a very active diuretic, 397. 

Magnesium sulphate concentrated, 343. 

Podophyllum, 363. 

Potassium acetate, 386. 

Saline purgatives, 342-7. 

Scoparius, 397. 

Sparteine (in cardiac), 285. 

Squill, 388. 

Taraxacum, 396. 



DYSENTERY, ACUTE. 

Acacia, 562. 

Brandy, 219. 

Camphor, 125. 

Castor-oil, must be given early, 335. 

Diet (see Acute diarrhoea). 

Dover's powder, 87. 

Erigeron oil, 393. 

Glycerin enema, 577. 

Hope's camphor mixture, 126. 

Indian hemp, 108. 

Ipecac in large doses, 325. 

Magnesium sulphate, 343. 

Opium, 86. 

Rochelle salt, with opium, 347. 

Ulmus, 562. 

Wines, Red and Port, 218. 
DYSENTERY, CHRONIC. • 

Alum waters, 2 1 2- 13. 

Astringent enemata, 375. 

Catechu, 190. 

Cetraria, 570, and Chondrus, 571. 

Copper sulphate, 203. 

Corrosive sublimate, 439. 

Diet (see Acute diarrhoea). 

Hematoxylon, 192. 

Kino, 191. 

Krameria, 19 1-2. 

Lead preparations, 199. 

Nutgall, 189. 

Silver nitrate, 207. 

Tannin, 187. 
DYSMENORRHCEA. 

Acetanilide as anodyne, 507. 

Aconite, when due to taking cold, 
240. 

Amyl nitrite, 312. 

Apiol to relieve the pain, 423. 

Belladonna, 99. 

Camphor, 125. 

"Ergot, 273. 

Guaiac, 382. 

Indian hemp, 108. 

Sumbul, 320. 

Uterine examination necessary to de- 
termine cause, then appropriate 
remedy, as correction of displace- 
ment ; the evacuation of clots by 
dilating cervix with tent, 566, etc. 

Viburnum, 319. 
DYSPEPSIA. 

Alkalies to relieve acidity, 254, 472-84. 

Alcohol as stomachic, 217. 

Aloe, if costive, 356. 

Ammonia water to relieve acidity and 
flatulence, 221. 

Aromatics, if flatulent, 222, 234. 

Arsenic, 461. 

Bitters, as Quassia, 140; Gentian, 141 ; 
Calumba, 142. 

Capon Springs water, 478. 

Carbonic acid waters, 561. 



622 



INDEX OF DISEASES AND REMEDIES 



DYSPEPSIA (continued). 

Chirata, 143 ; Anthemis, 146 ; Eupa- 
torium, 147 ; Cascarilla, 149. 

Change of air, habits, and location. 

Charcoal, as absorbent of acrid secre- 
tions, 538. 

Cinchona and Quinine, 156. 

Creta praeparata in acidity, 483. 

Diet, readily assimilated. 

Exercise in open air. 

Fowler's solution, 463. 

Ginger, 228. 

Homburg and Kissengen waters if 
anemic, 350. 

Ipecac, if deficiency of bile, 325. 

Lactic acid, 182. 

Leamington water, 351. 

Liquor calcis, if vomiting, 483. 

Magnesia and purgatives if constipated, 
342. 

Michigan Congress Spring, 348. 

Mineral acids, 177-80-81. 

Naphthaline, as intestinal antiseptic, 
518. 

Papaya, 164. 

Pepsin, 162. 

Rhubarb, 354. 

Saratoga waters, 348. 

St. Louis spring waters, 478. 

Strontium bromide, 301. 

Strychnine, 265. 

Vichy and Fachingen waters, 479. 
DYSPNCEA, CARDIAC. 

Amyl nitrite, 312. 

Digitalis with nux vomica, 264. 

Lobelia, 306. 

Morphia hypodermically, very effec- 
tive, 87. 

Nitroglycerin, 314. 

Sparteine, 285. 
EARACHE. 

Aconite, 230. 

Cocaine topically, 134. 

Laudanum and olive-oil, warm, ap- 
plied within auditory canal, 89. 

Morphia, hypodermically, 87. 
ECLAMPSIA (see Puerperal convul- 
sions). 
ECTHYMA. 

Baths, tepid, to soften crusts, 41. 

Lead water lotion to antagonize in- 
flammation, 200; then dress with 
Bismuth, 210; or Zinc oxide oint 
ment, 205 ; or Iodoform, Boric acid 
and Bismuth ointment, 210. 
ECZEMA, ACUTE. 

Bismuth subnitrate ointment, 210. 

Black wash and Zinc oxide ointment, 

435- 
Boric acid, 493. 

Carbolic acid to relieve pruritus, 501. 
Cocaine topically, 134. 



ECZEMA, ACUTE (continued). 

Collodion, flexile, as protective, 580. 

Dermatol topically, 537. 

Gelsemium internally to allay itching, 
316. 

Icthyol, topically, 537. 

Infusum picis liquidse, 407. 

Lead acetate solution to allay inflam- 
mation, 200. 

Poultices, if much infiltration with 
crusts, 559. 

Regulate bowels and digestive func- 
tions. 

Salicylic acid, 514. 
. Starch and Zinc oxide dusting powder, 
204. 

Tar, topically, 406. 

Viola tricolor as laxative, 332. 
ECZEMA, CHRONIC. * 

Arsenic, 461. 

Baths, natural hot, 41. 

^Blisters to stimulate skin to healthy 
action, 545-8. 

Corrosive sublimate ointment, 440. 

Diachylon ointment, 201. 

Electricity, 50. 

Fowler's solution, 462. 

Hebra's ointment (foot-note), 201. 

Infusum picis liquidae, 407. 

Icthyol, topically, 537. 

Lanolin, a good lubricant, 575. 

Leuk water baths, 484. 

Pix liquida and Sulphur ointment, 406. 

Potassium iodide, 450. 

Resorcin in squamous form, 511. 

Sapo viridis, to cleanse and stimulate, 
556. 

Sarsaparilla, 381. 

Sulphur waters, 338-9-40. 

Viola tricolor as laxative, 332. 

Zinc phosphide, 185. 
EMPHYSEMA. 

Cod-liver oil, 454. 

Ferric chloride tincture, 170. 

Morphia, hypodermically, for asthma, 

Nux vomica, for dyspnoea, 204. 

Quinine, 156. 
EMPYEMA. 

Adhesive plaster to promote absorp- 
tion, 36. 

Aspiration, 39. 

Bandages to promote absorption, 36. 

Carbolic acid, 500. 1 To be injected 

Iodine tincture, 447. J into the pleura. 
ENDOCARDITIS. 

Aconite to tranquillize heart, 238. 

Alkalies, if rheumatic, 473-478. 

Alcohol to sustain heart, 217. 

Blister to prsecordium, 538-550. 

Salicylic acid, if due to rheumatism, 
514. 



INDEX OF DISEASES AND REMEDIES. 



628 



ENDOMETRITIS. 

Bath, hot hip, 40. 

Carbolic acid, topically, 501. 

Ems water, 480. 

Iodine tincture, topically, 447. 

Leeches, 36. 

Nitric acid to uterine cavity, 179. 

Warm water, uterine irrigation with, 
40. 
ENTERALGIA (see Colic, intestinal). 
ENTERITIS. 

Acacia, 362. 

Brandy to stimulate, 217. 

Calomel, 436. 

Castor-oil, 1st stage, 335. 

Copper sulphate, 203, or Zinc sulphate, 
204, to prevent diarrhoea. 

Diet ; liquid, milk and beef-tea. 

Opium or Morphia later to keep in- 
testines at rest, 87. 
EPIDIDYMITIS (see Orchitis). 
EPILEPSY. 

Acetanilide, 506. 

Ammonium valerianate, 127. 

Amyl nitrite, to arrest seizure, 312. 

Bromides are the best remedies, as 
Potassium, 299; Ammonium, 300; 
Lithium, 301 ; Zinc, 301. 

Hydrobromic acid dilute, 301. 

Ice-bag to spine, 42. 

Iron-preparations, 165. 

Medicinal treatment often useless till 
exciting cause is ascertained, as 
dental or ocular defects, pressure 
upon cerebrum, etc. 

Paraldehyd, 92. 

Sumbul, 320. 

Woorara, 388. 

Zinc valerianate, 206. 
EPISTAXIS. 

Carbolized oil, 501. 

Cotton-plug within nares, 276. 

Monsel's solution and lint, plugging 
nostrils with, 169. 

Position upright, head thrown back. 

Tannin and cotton-wad, 187. 
ERUCTATION (see Acidity). 

Antifermentative agents as 

Carbolic acid, 500 ; Creasote, 503 ; 
Salicylic acid, 514. 

Charcoal as absorbent, 538. 
ERYSIPELAS. 

Antipyretics as, Antipyrin, 527; Chin- 
oline, 522; Resorcin, 511 ; Thai- 
line, 525. 

Boric acid in phlegmonous, 493. 

Carbolic acid, 500. 

Cotton-dressing, 276. 

Ferric chloride, tincture of, 170. 



Iodine, 447, 
Iodoform, 531, 
Lunar caustic, 552. 



topically. 



ERYSIPELAS (continued). 
Olive-oil inunction, 333. 
Potassium permanganate, 486. 
Quinine with iron the best remedy, 

Silver nitrate topically, 208. 
ERYTHEMA. 

Carbolic ointment, 501. 

Icthyol topically, 537. 

Lunar caustic, 552. 

Zinc oxide ointment benzoinated, 205. 
EXCORIATIONS. 

Collodion flexile, 580. 

Court plaster, 573. 

Goulard's cerate, 200. 

Liquor gutta perchae, 580. 

Resin cerate, 407. 

Starch-powder, 573. 
EXHAUSTION. 

Alcoholics, 217-20. 

Bath, hot, 40. 

Coca, 130. 
EXOPHTHALMIC GOITRE. 

Belladonna with ergot, 99. 

Digitalis, 281. 

Galvanism to neck, 47. 

Quinine, 156. 
FACIAL PALSY. 

Blisters to mastoid, 545-8. 

Electricity, 47. 

Hot applications to angle of jaw when 
due to cold, 40. 

Massage of facial muscles, 52. 
FAVUS. 

Poultices to remove crusts, 558-9 ; 
then depilate hairs and apply para- 
siticides as Carbolic acid, 501 ; 
Chrysarobin, 557; Naphthol, 520; 
Sulphurous acid lotion, 491 ; Sul- 
phur ointment, 337 ; Tar and Io- 
dine, 407. 
FEET, FETOR OF. 

Boric acid, 493. 

Condy's fluid, 487. 

Chromic acid, 554. 

Resorcin, 511. 

Sapo viridis, 556. 
FELON. 

Carbolic acid, 501, and Cocaine, 134, 
to relieve pain before evacuation. 

Poultices, hot flaxseed, 559. 
j FEVER. 

Aconite, as cardiac sedative, 238-9. 

Ammonium acetate liquor, a refriger- 
ant, 256. 

Antipyretics, Acetanilide, 506 ; Anti- 
pyrine, 527; Resorcin, 511 ; Sali- 
cylic acid, 514; Thalline, 525. 

Baths, cold, 42. 

Cold drinks, 43. 

Cold spongings, 42 ; with Vinegar, 259. 

Cracked ice, 43 ; Ice-water, 560. 



624 



INDEX OF DISEASES AND REMEDIES. 



FEVER (continued). 

Digitalis 280-1. 

Hoffman's anodyne, 138. 

Mustard and hot water to feet, 541. 

Neutral mixture, 256. 

Quinine, 155. 
FEVER, HECTIC (see Phthisis). 
FISSURE OF NIPPLES. 

Alum lotion, 212. 

Borax and Boric acid lotion, 494. 

Deshler's salve, 407. 

Lead nitrate, 201. 

Tannin, 187. 
FISTULA. 

Carbolic lotion, syringing with, 501. 

Iodoform, with sterilized lint, 531. 

Lunar caustic, 552. 
FLATULENCE. 

Alcohol after meals, 217. 

Aloe and asafetida pills, if constipated, 

357- 
Aromatics, 223-34. 
Garlic, 402. 
Ginger, 228. 
Peppermint water, 232. 
Purgative enemata, 375. 
Sodii bicarbonas, 478. 
FRACTURES. 

Adhesive plaster in making extension, 

407. 
Blisters, 545-8. 
Carbolic acid dressing in compound, 

-, 5 01 ; 
Etherization, in setting, 114. 

Lime phosphate, precipitated, 464. 

Sodii silicas, as permanent dressing, 

5 8l. 

FRECKLES. 

Alkaline lotions, as Liquor potassse, 

474, followed by unguents. 

Corrosive sublimate, 440, gr. j, in 

almond mixture, f^j. 

Sapo viridis, 556. 

FROST-BITE (see Chilblain). 

GALACTAFUGE. 

Atropia, 100. 

Potassium sulphate, 346. 

GALACTAGOGUE. 

Castor-oil leaves, decoction of, to 

breasts, 336. 

Faradization, 49. 

Pilocarpia, 379. 

GALLSTONES (see Biliary calculi). 

Ether, 1 12, 3 parts, and turpentine, 2 

parjs, in capsule, to dissolve. 

Etherization, 114. 

Michigan Congress Spring, 348. 

Morphia, hypodermically, to relieve 

pain, 87. 

Poland and Bedford springs water, 479. 

Sodium phosphate, as solvent, 345. 

Vichy and Fachingen waters, 479. 



GANGRENE. 

Alcohol, 217. 

Bromine as caustic, 555. 

Carbolic acid, topically, 550. 

Charcoal or Yeast poultice, 559. 

Liquor hydrargyri nitratis, 444, 555. 

Potassium permanganate, 487. 
GASTRIC CATARRH. 

Acacia, 562. 

Bismuth subnitrate, 209. 

Calomel, 436. 

Carlsbad water, 351. 

Diet: milk, alone or with Alkaline 
mineral waters, 478-80. 

Eucalyptus, 145. 

Friedrickshall water, 351. 

Hydrastis, 267. 

Nutrient enemata, 376. 

Salicylic acid as antizymotic, 514. 

Silver nitrate, in chronic cases, 207. 
GASTRO-INTESTINAL CA- 
TARRH (see Gastric catarrh). 

Resorcin, 511, and Naphthaline, 518, 
as antifermentatives. 

Sinapism to epigastrium, 541. 
GASTRODYNIA. 

Bismuth subnitrate, a gastric sedative, 
209. 

Cocaine, 135. 

Codeia, 90. 

Hydrocyanic acid dilute, 309. 

Manganese black oxide, 176. 

Nitroglycerin, 314. 

Resorcin, 511. 

Strontium bromide, 301. 
GINGIVITIS. 

Borax, 494, and Boric acid, 493. 

Carbolic acid, 501. 

Myrrh, 417. 
GLAUCOMA. 

Eserine, topically, 292. 
GLEET. 

Alum with cubeb, 211. 

Catechu injection, 190. 

Copaiba, 409. 

Corrosive sublimate, weak injection of, 
440. 

Hydrastis, internally and externally, 
267. 

Liquor calcis injection, 483. 

Mineral astringents, 203-4-5, 208, 212. 
Often advantageously injected with 
deep urethral syringe. Surgical in- 
terference frequently necessary. 

Resorcin injection, 511. 
GOITRE. 

Iodine tincture, injection of, 447, and 
internally, 446. 

Iodine ointment, 448. 

Potassium iodide, 450. 
GONORRHOEA, MALE. 

Alum with cubeb, 211. 



IXDEX OF DISEASES AND REMEDIES. 



625 



GONORRHOEA, MALE (continu'd). 

Alum injection, 212. 

Aluminum sulphate injection, 212. 

Baths, hot hip, to alleviate strangury, 
40. 

Boric acid injection, 494. 

Catechu injection, 190. 

Chapman's mixture, 410. 

Chloral injection, 295. 

Cocaine injection, to prevent ardor 
urinse, 134. 

Copaiba, 409. 

Copper sulphate injection, 203. 

Cubeb, 411. 

Erigeron oil, internally, 393. 

Hydrastine injection, 267. 

Hydrargyri corrosivum sublimatum in- 
jection, after acute stage, 440, 489. 

Iodoform injection, 531. 

Kino injection, 191. 

Liquor potassse to neutralize urine, 

474-. 
Plumbi acetas injection, 200. 
Potassium permanganate, one of the 

best injections, 487. 
Salicylic acid injection, 515. 
Sandal wood oil, internally, 412. 
Silver nitrate injection, 208. 
Tannin injection, 187. 
Thalline injection, 526. 
Zinc acetate, 205, and sulphate in 

jection, 204. 
GONORRHOEA, FEMALE. 
Carbolic acid injection, 501. ] 
Corrosive sublimate injec- I 

tion, 489. 
Potassium permanganate in- ! all in 

jection, 487. j warm 

Silver nitrate injection, 208. I water. 
Vinegar and water injection, | 

258. J 

Warm water injection, 40. 
GOUT. 

Ballston Spa water, 481. 

Baths, natural hot, 41 ; Sulphur, 338, 

339, 340. 

Blisters, 545. 

Caledonian Springs, 349. 

Carlsbad in chronic, 351. 

Colchicum the remedy, 392. 

Diet, very important ; should consist 
of tarinaceoua articles and acid 
fruits. 

Kissengen water, if plethoric, 350. 

Lartigue's colchicum gout-pills (foot- 
note), 392. 

Lemon juice, 259. 

Lithium bromide, 301. 

Lithium preparations, 481. 

Lithium salicylate, 515. 

Morphia, hypodermically, to relieve 
pain, 86. 

40 



GOUT (continued). 

Poland and Bedford Springs water, 

479- 

Potassium acetate, a diuretic and to 
lessen urea and uric acid, 386. 

Potassium, bicarbonate, as antacid in 
gouty diathesis, 475. 

Potassium iodide, 450. 

Rochelle salt as aperient, 347. 

Salicylic acid, 174; or Sodium sali- 
cylate, 515. 

Saratoga water in gouty diathesis, 348, 
482. 

Scudamore's draught, 392. 

Soap liniment, 126. 

St. Catherine's Wells water, 348. 

Vichy and Fachingen water, 479. 

Wiesbaden water, 351. 
GRANULAR LIDS (see Ophthal- 
mia). 
GRAVEL (see Calculi and Uric acid 

diathesis). 
HAIRS, SUPERFLUOUS, TO RE- 
MOVE. 

Electrolysis, 50. 
HAY FEVER. 

Antipyrine, 527. 

Bromine, by inhalation, 555. 

Carbolic spray, 500. 

Cocaine spray, 135. 

Grindelia, 320. 

Iodine vapor, 447. 

Quinine, 156. 
HEMATEMESIS. 

Creasote, 503. 

Ergot, 273. 

Hamamelis, 193. 

Liquor ferri nitratis, 172. 

Mineral acids, 177. 

Monsel's solution, 169. 
HEMATURIA. 

Ergot, 273. 

Gallic acid, 188. 

Hamamelis, 193. 

Ice-bags to renal region, 42. 

Liquor ferri nitratis, 172. 
HEMOPTYSIS. 

Alum, atomized, 212. 

Apomorphia, 328. 

Creasote, 503. 

Ergot, 273-4. 

Gallic acid, 188. 

Monsel's solution, atomized, 169. 
HEMORRHAGE (see also the three 
previous diseases). 

Blood-letting, 34. 

Catechu, 190. 

Capillary oozing, Monsel's solution, 
169. 

Carbolic acid, 501. 

Cold water or ice, 42. 

Galvanic cautery, 51. 



626 



INDEX OF DISEASES AND REMEDIES. 



HEMORRHAGE (continued). 

Geranium, 193. 

Granatum, 558. 

Kino, 190. 

Krameria, 191. 

Lead acetate, 190. 

Styptic collodion, 580. 

Transfusion of blood, 76. 
HEMORRHAGE, CEREBRAL (see 

Apoplexy). 
HEMORRHAGE, INTESTINAL. 

Astringent enemata, 375-6. 

Ergot extract, 273 ; (see foot-note p. 

274)- 

Ice-water enemata, 376. 

Liquor ferri-nitratis, 172. 

Mineral acids, 177. 

Monsel's solution, 169. 

Opium, 87. 
HEMORRHAGE, RECTAL. 

Astringent enemata, 375-6. 

Astringent suppository of Opium and 
Lead, 200, or Tannin, 187. 
HEMORRHAGE, UTERINE (post 
partum). 

Bark of cotton-root, 276. 

Blood, defibrinated, 75. 

Blood, transfusion of, 76. 

Digitalis, 280. 

Ether, hypodermically, to cause reac- 
tion, 112. 

Ergot extract, hypodermically, 273-4. 

Faradization, 50. 

Gallic acid, 188. 

Hot water, injected within uterus, 40. 

Hydrastis, 267. 

Iodoform-cotton tampon, 276. 

Nitric acid on cotton, after removal of 
polyp, 179. 
HEMORRHAGE, VAGINAL. 

Cold water, injected into vagina, 43. 
HEMORRHOIDS. 

Anodyne enemata, 376. 

Astringent enemata, 375. 

Belladonna ointment, 101. 

Carbolic injection, not altogether safe, 
501. 

Castor-oil, a good laxative, 335. 

Hamamelis, externally and internally, 

193. 

Krameria, topically, 192. 
Nutgall ointment, 190. 
Opium, Belladonna and Tannin oint- 
ment, very serviceable, 88. 
Stramonium, topically, 102. 
White-oak bark enema, 193. 
HEADACHE. 

Acetanilide, 506. 

Aconite, if there be cardiac overaction, 

238-9. 
Ammonium valerianate, 128. 
Antipyrine, 527. 



HEADACHE (continued). 

Caffeina, 130. 

Camphor spirit, 1 26. 

Chloroform, in nervous, 118. 

Ether, topically, 112. 

Glasses to correct refraction-errors. 

Guarana, 136. 

Hydrobromic acid, 301. 

Menthol, topically, 232. 

Mustard and hot water to feet, 541. 

Potassium bromide, 299. 

Quinine, if malarial, 156. 

Sodium bicarbonate, 478, with Vege- 
table bitters, 140-3 in dyspeptic 
cases before meals. 

Sodium salicylate, 515. 

Tea, strong cup of, 129. 

Valerian, occasionally useful, 127. 
HEART, AORTIC CONSTRIC- 
TION AND REGURGITA- 
TION OF. 

Digitalis, if heart's action be feeble, 
281. 
HEART-BURN. 

Alkalies, 473. 

Ammonia, aromatic spirit of, 482. 

Lactic acid, 182. 

Liquor potassse, 474. 

Magnesia, 342. 

Phosphoric acid dilute, 181. 
HEART, DILATATION OF. 

Cimicifuga, with languid circulation 
and oppressed breathing, 287. 

Digitalis, 281. 

Ferric chloride tincture as tonic, 170. 

Strychnine, 264. 
j HEART, FATTY. 

Same as above ; also nitroglycerin, 

3H. 
HEART, HYPERTROPHY OF. 

Aconite tincture, the best remedy, 240. 

Potassium bromide, 298. 

Recumbent posture, 240. 

Veratum viride, 244. 
HEART, IRRITABLE. 

Digitalis, 281. 

Potassium bromide, 298. 

Sparteine, 285. 
HEART, MITRAL REGURGITA- 
TION OF. 

Adonidine, 283. 

Digitalis, 281. 

Iodoform, occasionally, 530. 

Sparteine, 285. 

Strophanthin, 284. 
HEART, OVERACTING (see Hy- 
pertrophy). 
HEART, PALPITATION OF. 

Aconite tincture^ 240. 

Cocaine, if weak and irregular, 135-6. 

Potassium bromide, 298. 

Sparteine, 285. 



INDEX OF DISEASES AND REMEDIES. 



627 



HEMIPLEGIA. 

Cod-liver oil, 454. 

Electricity, 46. 

Ferric chloride, tincture of, 170. 

Massage to affected part, 52. 

Nux vomica, 264. 
HEPATITIS. 

Ammonium chloride in chronic, 468. 

Mercurial plaster, 433. 

Michigan Congress Spring water, 348. 

Nitro-muriatic acid internally and as 
bath, 1 80- 1. 

Poland and Bedford water, 479. 

Potassium iodide (in cirrhosis), 450. 
HERNIA. 

Bath, warm, 45. 

Enemata, forced of warm water, 375. 

Etherization, for taxis, 1 14. 
HERPES. 

Arsenic for "oral cankers," 461. 

Black wash, 435. 

Calomel, topically, 437. 

Fowler's solution When persistent, 
462. 

Zinc oxide ointment benzoinated, 205. 
HERPES ZOSTER. 

Belladonna ointment' to parts, 101. 

Collodion (f^^), and Morphia (gr. 
ij-v), 580. 
applied with a brush, 580. 

Galvanism sometimes relieves the pain, 

Icthyol, 537. 

Peppermint oil topically to allay pain, 

233- 

Zinc oxide ointment benzoinated, 205. 

Zinc phosphide internally to relieve 
the neuralgic pain, 185. 
HICCOUGH. 

Amber oil, 138. 

Camphor spirit, 1 26. 

Pilocarpine hypodermically, 379. 

Potassium bromide, 298. 
HOARSENESS. 

Barley-sugar, 582. 

Borax lozenge, 494. 

Catechu troches, 190. 

Croton oil, 551, or Iodine tincture, 447, 
to larynx externally. 

Liquorice lozenge, 568. 

Potassium chlorate lozenge, 470. 

Wistar's cough lozenge, 88. 
HYDROCELE. 

Adhesive or rubber plaster to promote 
absorption, 407. 

Aspiration, 39. 

Carbolic acid, 500, or Iodine tincture 
injected into sac, 447. 
HYDROCEPHALUS. 

Aspiration, 39. 

Potassium iodide to promote absorp- 
tion, 450. 



Hydragogue cath- 
artics. 



HYDROPHOBIA. 

Chloral, 295. 

Chloroform inhalation, 118. 
Morphia hypodermically, 85. 
Opium, 85. 
Woorara, 318. 
HYDROTHORAX. 
Aspiration, 39. 
Colocynth, 370. 
Elaterin, 371. 
Jalap, 362. 
Magnesium sulphate, concentrated, 

343- 

Juniper and Potash bitartrate, a pow- 
erful diuretic, 397. 

Scoparius, 397. 
HYPOCHONDRIASIS. 

Ferric chloride in anemic cases, 170. 

Moral treatment and change of scene 
are of first importance ; medicines 
secondary. 

Valerian, 127. 

Zinc phosphide as nerve-tonic, 185. 
HYSTERIA. 

Amber oil, 138. 

Ammonium valerianate, 127; carbon- 
ate, 222. 

Asafetida, 122. 

Camphor monobromated, 126. 

Chloral, 295. 

Ether, 112. 

Etherization, 114. 

Galvanism, 48. 

Hoffman's anodyne, 138. 

Hydrobromic acid dilute, 301. 

Indian hemp, 108. 

Iron-preparation, 166. 

Musk, 137. 

Paraldehyd as hypnotic, 92. 

Sulphonal as hypnotic, 94. 
ICTERUS (see Jaundice). 
IMPETIGO. 

Bismuth, Iodoform and Boric acid oint- 
ment, 210. 

Citrine ointment, 443. 

Zinc oxide ointment, benzoinated, 205. 
IMPOTENCE. 

Alcohol, 218. 

Auri et sodii chloridum, 444. 

Cantharides, 398. 

Electricity, 48. 

Nux vomica, 264. 

Phosphorus, 185. 
INCONTINENCE (see Urine). 
INFLAMMATION. 

Aconite, 238. 

Antipyretics, as Acetanilide, etc., 504. 

Blisters, 545. 

Blood-letting, 34. 

Cold water and ice, 42. 

Cups, 35. 

Digitalis, 280. 



628 



INDEX OF DISEASES AND REMEDIES. 



INFLAMMATION (continued). 

Lead preparations (Lead- water and 
laudanum) topically, 200. 

Leeches, 36. 

Mercurials, 428. 

Poultices, 559. 

Quinine to prevent exudation, 156. 

Saline cathartics, as Epsom salt, 343. 

Tartar emetic, 251. 
INFLUENZA. 

Antipyrine, 527. 

Camphor volatilized, 176. 

Eupatorium, 147. 

Iodine vapor, 447. 

Quinine, 156. 
INSANITY. 

Cold shower bath, 42. 

Indian hemp as cerebral stimulant, 108. 
INSECTS, BITES OF (see Virus of 

rabid animals). 
INSOLATION (see Sunstroke). 
INSOMNIA. 

Alcohol, 217. 

Chloral, 295. 

Hops, no. 

Hydrobromic acid dilute, 301. 

Hyoscine, 105. 

Hyoscyamus, 104. 

Hypnone, 94. 

Morphia or Opium, 85. 

Paraldehyd, 92. 

Potassium bromide, 298. 

Sulphonal, 94. 

Urethan, 95. 
INTERMITTENT FEVER. 

Aconite, to relieve headache and fever, 
240. 

Antipyrine to moderate fever, 527. 

Eucalyptus, 145. 

Iodine, 447. 

Morphia to abort, 87. 

Piperine when quinine fails, 225. 

Quinine the remedy, 154. 
INTERTRIGO. 

Bismuth dusted over parts, 2IO. 

Tannic acid ointment, 188. 

Zinc oxide powder or ointment, 105. 
INTUSSUSCEPTION. 

Enemata, forced, 375. 

Opium or Morphia with Belladonna, to 
allay pain and quiet spasm, 87. 

Violent purgation to be avoided, 330. 
IRITIS. 

Atropine with mercury, 100. 

Daturine, 102. ] 

Duboisia, 105. 

Homatropine, 1 00. 

Hyoscine hydrochlorate 

105. 
JAUNDICE. 

Ammonium iodide, after acute symp 
toms, 451. 



To dilate 
pupil. 



JAUNDICE (continued). 

Calomel in minute doses continued, 

437- 

Carlsbad water, 351. 

Colocynth, hepatic stimulant, 369. 

Diet ; avoid fatty, starchy and saccha- 
rine foods ; milk and beef-essence 
are suitable. 

Diuretics to eliminate bile, as Potas- 
sium acetate, 386 ; Potassium bitar- 
trate and Juniper, 397. 

Hydrastis, 267. 

Iris, 367. 

Lemon juice, 259. 

Manganese sulphate, 176. 

Nitro-muriatic acid, 180. 

Salol, 517. 

Sanguinaria, 327. 
JOINTS, AFFECTIONS OF. 

Burgundy pitch plaster, 543. 

Croton oil as counterirritant, 373. 

Etherization in breaking up adhesions 
and in dislocations, 114; also Hot 
baths, 40. 

Frictions, 36. 

Iodine tincture, topically, in thicken- 
ings about, 447. 

Linimentum saponis, 126. 

Mercurial plaster, 433. 

Turpentine as rubefacient, 405. 
KELOID. 

Collodion, 580. 
KERATITIS. 

Bathing eyes in cold water to relieve 
photophobia, 42. 

Cod-liver oil, 454. 

Eserine (gr. ij to aq. f^j), to lessen 
ocular tension, 292. 

Leeches to temple, 1st stage, 36. 

Potassium iodide, 450. 
LABOR. 

Antipyrine to relieve pain in 1st stage 
528. 

Belladonna to relieve rigidity of os, 99. 

Castor-oil as unirritating laxative, 335. 

Chloroform inhalation when os is 
completely dilated, 117. 

Chloral to relieve rigidity of os, 295. 

Ergot in 2nd stage, 272. 

Quinine to promote uterine contrac- 
tions, 156. 

Etherization during the pains of, 1 1 5. 
LARYNGISMUS STRIDULUS. 

Bath, warm, immersion in, to prevent 
attack, 40. 

Belladonna, 99. 

Cold affusions, 42. 

Potassium bromide, 298. 
LARYNGITIS. 

Aconite, 239. 

Atomization, 73-4, 

Benzoin fumigation in chronic, 418. 



INDEX OF DISEASES AND REMEDIES. 



629 



373- 



As warm 
injections. 



LARYNGITIS (continued). 
Blisters over larynx, 548. 
Croton oil topically in chronic, 

Iodine applied over larynx, 447. 

Poultices, 559. 

Sinapism, 541. 
LEAD-PALSY (see Colica picto- 
num). 

Galvanism, 46. 

Nux' vomica, 264. 
LEPRA. 

Arsenic, 461. 

Fowler's solution, 462. 

Sulphur iodide, 452. 
LEUCORRHCEA. 

Alum, 212. 

Bark, white oak, 193. 

Hydrastis, 267. 

Kino, 191. 

Krameria, 192. 

Liquor calcis, 483. 
LICE (see Pediculosis). 
LICHEN. 

Arsenic, 461. 

Baths, natural hot, 41. 

Cold cream, 195. 

Fowler's solution, 462. 

Leuk water, 484. 

Petrolatum, 579. 

Pix liquida and Caustic potash to re- 
lieve itching, 406. 

Sulphur waters, 338-9-40. 
LITHURIA (see Uric acid diathesis). 
LIVER, AFFECTIONS OF. 

Abscess of, aspiration, 39. 

Cirrhosis, Ammonium iodide, 1st stage, 
451, and chloride, 468; Potassium 
iodide, 450. 

Engorgement of, Homburg water, 350 ; 
Sulphur waters and baths, 338-9-40. 

Hepatitis chronic, Nitro-muriatic acid, 
180. 

Torpor of, Ammonium chloride, 468 ; 
Euonymus, 367 ; Iris, 367 ; Lemon 
juice, 259; Potassium carbonate, 
475; Blue pill, 431 ; Calomel, 436 ; 
Grav powder, 433. 
LOCKJAW (see Tetanus). 
LOCOMOTOR ATAXIA. 

Acetanilide, 506. 

Antipyrine, 527. 

Exalgine, 508. 

Galvanism, 46. 

Massage, 52. 

Mercury, 428, or Potassium iodide, if 
specific, 450. 

Salol to relieve pain, 517. 

Silver nitrate, 207. 

Strychnine, 264. 
LUMBAGO. 

Antipyrine, 527. 



I Anodynes. 



LUMBAGO (continued). 

Atropine hypodermically, 98. 

Belladonna plaster, 100. 

Burgundy pitch plaster, 543. 

Electricity, 46. 

Exalgine, 508. 

Frictions, 36. 

Massage, 52. 

Morphia hypodermically, 87. 

Opium, 87. 

Salol, 517. 

Soap liniment, 126. 

Turpentine liniment, 405-6. 
LUPUS. 

Acetic acid glacial, 258. ") 

Aristol, 533. 

Arsenic, 462, 554. 

Carbolic acid, 501. 

Caustic potassa, 553. 

Chromic acid, 554. \ Topically. 

Liquor hydrargyri nitra- 
tis, 444- 

London paste, 553. 

Sulphur iodide, 452. 

Zinc chloride, 205, 555. J 

Phosphorus, internally, 185. 
LYMPHADENOMA. 

Fowler's solution, 463. 

Phosphorus, 185. 
MALARIAL CACHEXIA. 

Arsenic, 461. 

Carbolic acid and Iodine, 500. 

Quinine, 155. 

Vichy and Fachingen waters, 479. 
MALINGERING. 

Etherization, 114. 

Faradization, 43. 
MANIA, ACUTE. 

Chloral, 295. 

Conium, 289. 

Gelsemium, 316. 

Hyoscyamine sulphate, 104. 

Hyoscine hydrochlorate, 105. 

Indian hemp, 109. 

Morphia hypodermically, 85. 

Opium, 85. 

Paraldehyd, 92. 

Potassium bromide, 298. 

Sulphonal, 94. 
MANIA-A-POTU. 

Chloral, 295. 

Hops in mild cases, 1 10. 

Indian hemp, 109. 

Morphia hypodermically, 85. 

Opium, 85. 

Potassium bromide, 298. 
MASTURBATION. 

Avoid sedentary life and habits. 

Blistering glans penis, 550. 

Gelsemium tincture as motor-depres- 
sant, 316. 

Potassium bromide, 299. 



630 



INDEX OF DISEASES AND REMEDIES. 



MEASLES. 

Aconite in sthenic cases, 240. 
Antipyretics as Quinine, 156, and 

Antipyrine, 527. 
Fatty inunciions, 573; of Olive-oil, 
333; of Pettolatum, 579. 
MELANCHOLIA. 

Caffeina as cerebral stimulant, 130. 
Cannabis Indica, 108. 
Cocaine, 135. 
Fowler's solution, 463. 
Sulphonal as calmative, 94. 
Valerian, 127. 
MENINGITIS, CEREBRAL. 
Aconite, 239. 

Blisters to nape of neck, 545-8. 
Cold to head, 42. 
Opium or Morphia, 87. 
Potassium bromide, to allay irritation, 

298. 
Purgatives (salines) at beginning, 

342. 
Sinapism to nape of neck, 541. 
MENINGITIS, SPINAL (see Cere- 
bral. 
MENOPAUSE. 

Cathartics as Blue pill, 431 ; Hunyadi 
Janos, 351, or Friedrickshall water, 

35 1 : 

Potassium bromide, 299. 

MENORRHAGIA. Is only a symp- 
tom and requires careful ex- 
amination to ascertain cause. 

Cimicifuga, 287. 

Digitalis, 280. 

Nitric acid, 179, or Silver nitrate, 208, 

to cauterize cervix or canal if due to 

erosions. 
MERCURIALISMUS. 
Atropine, 99. 

Astringent gargles as solution Chlo- 
rinated soda, 489 ; Liquor calcis, 

483, or Alum, 212. 
Lunar caustic, 208, if sloughing 

sores. 
Potassium iodide as eliminator, 450. 
METRITIS. 

Glycerin alone or with Carbolic acid, 

577-8. 
Hot water uterine irrigation, 40. 
Leeches, first stage, 36. 
MIGRAINE. 

Ammonium valerianate, 128. 

Blue mass, 431, followed by Seidlitz 

powder, 347. 
Caffeine, 130. 
Electricity, 46. 
Exalgine, 508. 
Guarana, very useful, 136. 
Ipecac, 325. 
Magnesia, 342. 
Salol, 517. ■ • 



MUCOUS PATCHES (see Condy- 
lomata). 
MYALGIA. 

Antipyrine, 527. 

Atropine hypodermically, 98. 

Linimentum terebinthinse, 406. 

Morphia hypodermically, 87. 

Salol, 517. 

Sinapisms, 541. 

Soap liniment, 126. 
MYELITIS. 

Ergot, 273. 

Ice-bag to spine, 42. 

Leeches to spine, 36. 
MYRINGITIS. 

Borax or Boric acid finely powdered 
and insufflated, 494. 

Carbolic acid topically, 501. 

Cocaine topically, 134. 

Leeches to mastoid, 36. 

Scarifications of membrana tympani, 
36. 
N^VI. 

Cauterization with Nitric acid, 179; 
Vienna, 553, or London paste, 553, 
if superficial. 

Liquor ferri subsulphatis injection, 169. 
NARCOSIS. 

Ammonia water as stimulant, 221. 

Apomorphia hypodermically, 328. 

Cold affusions, 42. 

Copper sulphate, 203; Zinc sulphate, 
204; or Mustard emetic, 541. 

Electricity, 50. 
NAUSEA. 

Ammonia, aromatic spirit of, 482. 

Apollinaris water, 561. 

Bismuth, 209. 

Carbonic acid water, 561. 

Calomel, 436. 

Clvsmic water, 561. 
NEURALGIA. 

Acetanilide, 506. 

Aconite and Aconitine, 238-40-1. 

Acupuncture, 36. 

Antipyrine, 527. 

Ammonium valerianate, 127; Bis- 
muth valerianate, 210. 

Arsenic, 461. 

Baths, natural hot, 41. 

Belladonna, 98 ; Liniment of, 1 00. 

Cocaine, 1 34-5. 

Croton- chloral hydrate, 295. 

Dulcamara, rarely, ill. 

Electricity, 46. 

Exalgine, a new remedy, 508. 

Gelsemium, 316. 

Ichthyol topically, 537. 

Indian hemp, 108. 

Iron, 166. 

Menthol topically, 232. 



fXDEX OF DISEASES AND REMEDIES. 



631 



NEURALGIA (continued). 

Opium, 85. 

Phosphorus, 185. 

Quinine, 156. 

Salol, 517. 

\ eratrine, topically, 246. 
NEURASTHENIA. 

Alcohol, 217. 

Hydroc) anic acid dilute, for irritability, 

Malt-extract, 211. 

Massage, 52. 

Phosphorus, 185. 

Sulphonal, 94. 

Weir Mitchell treatment, 52. 
NIGHTMARE. 

Potassium bromide, 298. 
NIGHT SWEATS. 

Atropine hypodermically, 99. 

Picrotoxin, 267. 

Vinegar and water sponging with, 258. 
NYMPHOMANIA. 

Camphor, 125. 

Potassium bromide, 299. 
OBESITY. 

Alkalies 473, and Alkaline waters, 
478: 

Caledonian Springs, 349. 

Diet : avoid amylaceous and fatty arti- 
cles, alcohol and malt-liquors. 

Exercise up to the point of free diapho- 
resis. 

Homburg water, 350. 

Michigan Congress water, 348. 

Saccharin as substitute for sugar, 

583. 

Saratoga water, 348. 
OPHTHALMIA (see also Conjunc- 
tivitis). 

Alum topically, 212. 

Copper sulphate topically, 556. 

Cod-liver oil, if scrofulous, 454. 

Iodoform, 531. 

Sassafras pith, 566. 

Silver nitrate, 208. 

Yellow mercuric oxide ointment, 434. 

Zinc acetate, 205. 
OPHTHALMIA, GONORRHEAL. 

Atropia if perforation threatens, 100. 

Cold compresses to orbit, 42. 

Seal up sound eye with lint and collo- 
dion, 580. 

Silver nitrate collyrium, 208. 
ORCHITIS. 

After inflammation has subsided strap 
scrotum with Rubber or Adhesive 
plaster, 407. 

Lead water and laudanum, 200. 

Rest absolute. 

Support scrotum with oakum. 
OTORRHCEA. 

Aconite. 236. 



OTORRHCEA (continued). 

Aristol, 533. ) 

Bismuth subnitrate, 210. V Topically. 

Boric acid, 493. J 

Carbolic acid lotion, 501, syringe audi- 
tory canal with, then dry with Ab- 
sorbent cotton, 276, and pack with 
Iodoform, 531. 

Zinc acetate topically, 204. 
OXALURIA. 

Mineral acids injected into bladder, 
177. 

Nitro-muriatic acid internally and as 
bath, 1 80- 1. 
OZ.ENA. 

Bromine by inhalation, 555. 

Carbolic nasal wash, 501. 

Condy's fluid, 487. 

Potassium chlorate wash, 470. 
PARALYSIS. 

Acupuncture, 36. 

Arnica topically, 247. 

Baths, hot, 40. 

Baths, hot natural, 41. 

Cold douche, 42. 

Electricity, 46. 

Massage, 52. 

Nux vomica when nerve centres are 
unimpaired, 264. 
PARALYSIS AGITANS. 

Conium, 289. 

Ferric chloride tincture of, 170. 

Motor depressants, as Gelsemium, 316 ; 
Physostigma, 292; and Woorara, 
3i8. 
PARAPLEGIA. 

Electricity, 46. 

Massage, 52. 

Potassium iodide, if svphilitic, 450. 
PARASITES, INTESTINAL (see 

Worms.) 
PARONYCHIA. 

Lead water and Opium, 200. 

Lunar caustic, 550. 

Poultices, 559. 
PEDICULOSIS. 

Ammoniated mercury, 442. 

Corrosive sublimate lotion, 441. 

Mercurial ointment, 432. 

Picrotoxin, decoction or ointment, 
269. 

Staphisagria, 249. 
PEMPHIGUS. 

Arsenic, 461. 

Diachylon ointment, 201. 

Fowler's solution, 462. 

Hebra's ointment, (foot-note), 201. 

Puncture blebs. 

Zinc oxide and Starch, 204. 
PERICARDITIS. 

Aspiration, if effusion, 39. 

Bryonia, as hydragogue, 363. 



632 



INDEX OF DISEASES AND REMEDIES. 



PERICARDITIS (continued). 

Concentrated salines to remove effu- 
sion, 343. 

Digitalis, with feeble heart and dropsy, 
281. 

Sodium salicylate to antagonize rheu- 
matic origin, 514. 

Quinine before effusion, 156. 
PERITONITIS. 

Aconite, 239. 

Castor-oil, 351. 

Liquid, nourishing diet ; soda water 
and milk. 

Opium or Morphia, 86. 

Poultices, 559. 

Purgative enemata, 375. 
PHAGEDENA. 

Bromine, 555. 

Nitric acid, 179. 

Potassium permanganate, 487. 
PHARYNGITIS. 

Acacia, 552. 

Aconite tincture, 239. 

Alum gargle, 212. 

Cubeb-lozenge, 441. 

Ems water, 480. 

Potassium chlorate gargle, 470. 

Salvia gargle, 233. 

Silver nitrate topically, 208. 

Sumach gargle, 195. 

Tannin gargle, 187. 

Tannin troche, 188. 
PHOSPHATIC DIATHESIS. 

Lactic acid, 184. 

Mineral acids, 177 ; Hydrochloric di- 
lute, 180; Sulphuric dilute, 178. 

Oak-orchard acid spring water, 178. 
PHOTOPHOBIA. 

Atropine, 100. 

Bathing eyes in cold water, 42. 

Cocaine topically, 134. 

Eserine topically, 292. 

Horn atropine, 1 00. 
PHTHIRIASIS. 

Ammoniated mercury in vaseline, 
442. 

Arsenic, 461. 

Baths, natural hot, 41. 

Carbolic acid, 501, in ointment or 
glycerin preceded by shampooing 
with soap and water. 

Corrosive sublimate ointment, 440. 

Donovan's solution, 564. 

Fowler's solution, 462. 

Leuk water baths, 484. 

Pilocarpia, 379. 

Resorcin, 511. 

Sapo viridis, 556. 

Staphisagria, topically, 249. 

Sulphides in ointment, 338: Sulphur 
ointment, 337 ; Sulphur waters, 338 
-9-40. 



PHTHISIS. 

Acetanilide, 506. 

Aconite to moderate fever, 239. 

Alcohol, 218. 

Camphoric acid for sweating of, 125. 

Carbolic acid spray, 500. 

Coca, 130. 

Cod-liver oil, 454. 

Diet, nourishing and fat-producing. 

Fatty inunctions, 573. 

Ferrum hypophosphite, 172. 

Ferrum iodide, syrup of, 17 1. 

Hygienic measures, change to suitable 

climate. 
Iodine as counterirritant and vapor, 

447- 
Iodoform, 530. 
Iodol in laryngeal, 534. 
Lugol's solution injecte'd into cavities, 

448. 
Malt-liquors, 219. 
Morrhuol, 455. 
Quinine, 156, and Wild cherry, 162, 

for hectic of. 
Peppermint oil, 232, and Thymol by 

inhalation, 535. 
Picrotoxin for night-sweats of, 268. 
PITTING (see Small pox). 
PLEURITIS, ACUTE. 

Aconite tincture before effusion, 239. 

Bryony as hydragogue, 363. 

Cocaine hypodermically to relieve pain, 

135- 

Concentrated salines to remove dropsy, 

343- 
Gelsemium, 316. 
Iodine tincture to chest, 447. 
Morphia with Quinine early, 87. 
Pilocarpia after inflammation subsides, 

379-' 

Poultices, 559. 

Sodium salicylate, 515. 
PLEURITIS, CHRONIC. 

Aspiration, 39. 

Bandages, to promote absorption, 36. 

Iodine tincture to chest or injected 
into pleura, 447. 

Diuretics, 386-97, and Hydragogues, 
342-72. 
PNEUMONIA. 

Acetanilide, 506. 

Aconite tincture before exudation, 239. 

Antipyrine, 527. 

Alcohol, to sustain heart, 217. 

Ammonium carbonate, 222 ; chloride, 
467 ; iodide, 45 1 . 

Cimicifuga, 287. 

Dover's powder, 89. 

Eupatorium in latter stage, 147. 

Gelsemium, 316. 

Poultices, 559. 

Quinine, in small doses, 155. 



INDEX OF DISEASES AND REMEDIES. 



633 



PNEUMONIA (continued). 

Senega 399- I l„ latter stage. 

Wild cherry, 162. ) & 

Veratrum viride before exudation, 244. 
POLYURIA (see Diabetes insipidus). 
PORRIGO. 

Citrine ointment, 443. 

Corrosive sublimate ointment, 440. 

Picrotoxin, 269. 

Red oxide of mercury ointment, 434. 

Silver nitrate topically, 208. 
PREGNANCY. 

Castor oil, 335, I as laxatives 

Confectio sennae, 358, f 
PREGNANCY, EXTRA UTERINE. 

Electrolysis, 50. 
PRICKLY HEAT. 

Alkaline lotion, tepid, as Liquor po- 
tassae, 474; with Carbolic acid, 501. 

Black wash, 435. 

Carbolic acid as an antipruritic agent, 
501. 

Lead water, 200. 

Starch and Zinc oxide dusting powder, 

573- 

Tar- water, 407. 
PROCTITIS. 

Astringent and Emollient enemata, 376. 

Castor-oil, 335. 

Epsom salt, 343. 
PROLAPSUS ANI. 

Alum, 212. \ 

Tannin, 187. V By enemata. 

White oak bark, 193. J 
PROLAPSUS IRIDIS. 

Atropine and Homatropine, 1 00. 
PRURIGO and PRURITUS. 

Carbolic ointment, 501. 

Gelsemium, internally, 316. 

Hydrocyanic acid dilute, 309. 

Liquor calcis, topically, 483. 

Naphthol, 520. 

Oleum hydrargyri, 434. 

Pix liquida, 406-7. 

Thymol, 535. 
PRURITUS ANI and VULVAE. 

Carbolic acid ointment, 501. 

Cocaine, topically, 134. 
PRURITUS VAGINiE. 

Hops infusion, 1 10. 
PSORIASIS. 

Arsenic, 461. 

Baths, natural hot, 41. 

Baths, tepid alkaline, 41. 

Carbolic wash, 501. 

Chrysarobin, often cures, 559. 

Citrine ointment, 443. 

Donovan's solution, 464. 

Fowler's solution, 462. 

Lanolin, 575. 

Leuk water baths, 484. 

Naphthol, 520, 



PSORIASIS (continued). 

Phosphorus, 185. 

Pilocarpia, 379. 

Pix liquida and Sulphur, 406. 

Resorcin, 511. 

Sapo viridis, 556. 

Sulphides, 338. 

Sulphur ointment, 337. 

Sulphur waters, 338-9-40. 

Zinc phosphide, 185. 
PTYALISM (see Mercurialismus). 
PUERPERAL ECLAMPSIA. 

Amyl nitrite, 312. 

Chloral, 295. 

Etherization, 114. 

Morphia or Opium, 87. 

Nitroglycerin, 314. 

Pilocarpia, 379. 

Potassium, bromide, 299. 

Venesection, if plethoric, 34. 

Veratrum viride, 244. 
PUERPERAL FEVER. 

Antipyrine, 527. 

Iodoform bougie within uterus, 531. 

Quinine, 1.56. 

Salicylic acid, 514. 
PUERPERAL SEPTICEMIA. 

Corrosive sublimate, vaginal injection 
of, 489. 

Iodoform uterine bougie, 531. 

Opium, 86. 

Quinine, 155. 
PURPURA. 

Ergot, 273. 

Mineral acids, 177. 

Quinine, 156. 

Turpentine, oil, 405. 
PUSTULE, MALIGNANT. 

Caustic potassa, 552. 

Escharotics, 551. 

Iodine, injected, 448. 

Liquor hydrargyri nitratis, 555. 

London paste, 553. 
PYEMIA. 

Alcohol, 217. 

Carbolic acid, topically, 500. 

Diet, sustaining. 

Ferric chloride tincture of, 170. 

Potassium permanganate, 486. 

Quinine, 156. 

Salicylic acid, 514. 
PYELONEPHRITIS. 

Alkaline diuretics well diluted, as 

Potassium acetate, 386. 
Benzoic acid, 508. | Urinary antisep- 
Boracic acid, 493. j tics. 

Milk diet. 

Naphthaline, 518. \ Urinary antisep- 
Salol, 517. J tics. 

Turpentine oil, 405. 
PYROSIS. 

Arsenic, 461. 



634 



INDEX OF DISEASES AND REMEDIES. 



PYROSIS (continued). 

Bismuth subnitrate, 209. 

Carbolic acid, 500, and Creasote, to pre- 
vent decomposition of food, 503. 

Lime water, 483. 

Manganese oxide, 176. 

Silver nitrate, 209. 

Skim milk diet. 
RACHITIS. 

Calcii phosphas precipitatus, 465. 

Creta preparata, 484. 

Morrhuol, 454. 

Phosphoric acid dilute, 181. 

Phosphorus, 185. 

Sodium phosphate, 345. 
RECTOCELE. 

Alum, 212. } 

White oak bark, 193. } To P lcall y- 
REMITTENT FEVER (see Inter- 
mittent fever). 
RHEUMATISM, ACUTE. 

Acetanilide, 500. 

Ammonium bromide, 300. 

Antipyrine, 527. 

Chinoline, 522. 

Cold bath or pack, 42. 

Colchicum and Colchicine, 392-3. 

Cotton to joints, 276. 

Dover's powder, 89. 

Fuller's alkaline treatment, 475. 

Gaultheria, 231. 

Opium or Morphine, 86. 

Potassium acetate, 386. 

Potassium bicarbonate, 475. 

Quinine, 156. 

Salicin, 161. 

Salicylic acid, 514, or Sodium salicy- 
late, 515. 

Saline cathartics, 342. 

Salol, 516. 
RHEUMATIC ARTHRITIS. 

Ammonium muriate, with Huxam's 
tincture, 468. 

Arsenic, 461. 

Baths, natural hot, 41. 

Baths, warm, 40. 

Burgundy pitch plaster, 543. 

Cod-liver oil, 454. 

Croton oil to joints, 55 *• 

Ferric chloride, tincture of, 1 70. 

Guaiac, internally, 362. 

Iodine to joints, 447. 

Sodium carbonate, 477. 
RHEUMATISM, CHRONIC. 

Aconite, topically, 240. 

Acupuncture, 36. 

Ammonium muriate, 468. 

Arsenic, 461. 

Ballston Spa water, 481. 

Baths, hot and warm, 40. 

Baths, natural hot, and hot air, 41. 

Bedford Springs and Poland water, 479. 



RHEUMATISM, CHRONIC (con- 
tinued). 

Blisters, 545-8. 
Burgundy pitch plaster, 543. 
Caledonian Spring waters, 349. 
• Camphor, topically, 125. 
Carlsbad water, 351. 
Cold douche, 42. 
Cotton, 276. 
Cod-liver oil, 454. 
Electricity, 46. 
Frictions, 36. 

Iodine, topically to joints, 447. 
Lithium preparations, 481. 
Massage, 52. 
Menthol, topically, 232. 
Mezereum, 383. 
Phytolacca, 248. 
Potassium iodide, 450/ 
Saratoga water, 482; Wiesbaden, 351. 
Sarsaparilla, 381. 
Soap liniment, 126. 
Sodium phosphate, 346; Salicylates, 

515- 

St. Catherine's wells, 348; St. Louis' 

springs, 478. 
Stillingia, 385. 

Sulphur natural waters, 338-9-40. 
'Veratrine ointment, 246. 
RHEUMATISM, GONORRHCEAL. 
Anodyne poultices to joints, 560. 
Belladonna liniment, 100. 
Blisters, small, to parts early, 545-8. 
Potassium iodide, 450. 
Saline purgatives, 342-7. 
Salicylic acid, 514; Sodium salicylate, 

515. 

Treat the gonorrhoea. 409. 
RHEUMATISM, MUSCULAR (see 
Myalgia and Chronic rheu- 
matism). 
RINGWORM (see Tinea). 
ROSEOLA. 

Ordinarily no special treatment re- 
quired. Petrolatum, 579, or Zinc 
oxide ointment benzoinated, 205, to 
allay cutaneous irritation. 
RUBEOLA (see Measles). 
RUPIA. 

Antiseptic ointments of Peppermint Oil 
and Vaseline, on lint, 23 2, or Bismuth, 
Iodoform and Boracic acid, 210. 
Antisyphilitic treatment with Mercury, 

428, or Potassium iodide, 450. 
Citrine ointment, 443. 
Mercurial ointment, 432. 
SALIVATION (see Mercurialismus). 
SARCINA VENTRICULI. 
Carbolic acid, 500. 
Resorcin, 511. 
Salicylic acid, 5 J 4- 
Sulphurous acid, 491. 



IXDEX OF DISEASES AND REMEDIES. 



635 



SCABIES. 

Carbolic acid, 500. 

Liquor calcis, 483. 

Napthol, 520. 

Phytolacca, 248. 

Staphisagria, 249. 

Sulphides in form of ointment, 338. 

Sulphur ointment, 337. 
SCALDS (see Burns). 

Carbolic acid, 501. 

Glycerin treatment, 378. 

Goulard's cerate, 200. 

Liniment calcis (carron oil), 583. 

Sodium bicarbonate, sprinkled over, 
478. 
SCARLET FEVER. 

Aconite, to moderate pulse, 239. 

Acetanilide, 506. 

Adeps as fatty inunction, 574. 

Bath, cold, to moderate fever, 42. 

Carbolic acid internally (of doubtful 
utility), 500. 

Digitalis, 281. 

Glyceritum amyli to allay heat of skin, 

573- 

Petrolatum, 578; or Olive-oil, 333, as 
inunction. 

Potassium chlorate gargle for throat, 
470. 

Quinine as antipyretic, 156. 

Sodium benzoate, 509. 
SCIATICA. 

Aconitine topically, 241. 

Antipyrine, 527. 

Atropine hypodermically, 98. 

Blisters, Collodion cum cantharide, 
549 ; or a milder application, Charta 
sinapis, 541 ; both over nerve. 

Chloroform by deep injection, 117. 

Electricity, 48. 

Ether hypodermically, 112. 

Exalgine, a new remedy, 508. 

Quinine, often with Morphine or Atro- 
pine, 156. 
SCLEROSIS, SPINAL. 

Fowler's solution, 463. 

Potassium iodide, 450. 

Silver nitrate, 207. 
SCROFULA. 

Auri et sodii chloridum, 444. 

Calcii chloridum, 466 ; Phosphate, 464. 

Caledonian Springs water, 349. 

Cod-liver oil, 454. 

Iron-preparations, 166; Syrup of the 
iodide, 171. 

Iodine, 446-7 ; Unguentum iodi, 448, 
for tumefactions. 

Mercurial plaster for enlargements, 

433- 
Mercurous iodide, 441. 
Morrhuol, 454. 
Phosphoric acid dilute, 181. 



SCROFULA (continued). 

Potassium iodide, 450; Sulphur iodide, 

452. 

St. Catherine's wells water, 348. 
SCURVY. 

Green vegetable diet. 

Lemon juice, 259. 

Mineral acids, 177. 
SEASICKNESS. 

Amyl nitrite, 312. 

Chloral, 295. 

Nitroglycerin, 314. 

Purging before sailing. 

Rest in berth. 
SEPTICEMIA (see Pyemia). 
SHOCK. 

Alcohol, 217. 

Ammonia, 221. 

Cocaine hypodermically to sustain 
heart, 136. 

Quinine. 156. 
SMALLPOX. 

Alcohol if much depression, 217. 

Bromides, 298, or Morphia, 87, to 
produce sleep. 

Carbolic acid, 500. 

Diet, nourishing. 

Quinine as antipyretic, 156. 
SMALLPOX, Pitting of, to prevent. 

Collodion, 580. 

Emplastrum hydrargyri, 433. 

Glyceritum amyli, 573. 

Iodoform. 531. 

Liquor calcis, 483. 

Lunar caustic, 55 2 - 

Silver nitrate, 208. 

Unguentum hydrargyri, 432. 
SORDES. 

Carbolic acid and 
Myrrh, 417, 

Condy's fluid, 487, 
SPASM. 

Bath, warm, 40. 

Blood-letting, 34. 

Electricity, 46. 

Etherization, 114. 

Hydrocyanic acid dilute, 309. 

Morphia hypodermically, 86. 
SPERM ATORRHCEA. 

Bandage of rubber applied around 
penis and scrotum to prevent erection. 

Belladonna and Opium suppository, 100. 

Blisters to perineum, as Collodion cum 
cantharide, 549. 

Cold metal bougie to relieve urethral 
hyperesthesia. 

Electricity, 48. 

Hygienic measures ; exercise in open 
air, avoidance of erections and sen- 
sual thoughts. 

Lunar caustic to cauterize the deep 
urethra as last resort. 



I Mout 



636 



INDEX OF DISEASES AND REMEDIES. 



topically. 



SPERMATORRHOEA (continued). 

Nux vomica, 264. 

Potassium bromide, 299, with Gelse- 
mium, 316, as depresso-motor. 
SPINA BIFIDA. 

Aspiration, 39. 

Iodine tincture injection of, 447. 
SPINAL IRRITATION. 

Actual cautery, 41. 

Atropia and Morphia injected at seat 
of pain, 99. 

Ice-bag to spine, 42. 

Massage, 52. 

Weir Mitchell's treatment, 52. 

Veratrine ointment, 246, with Aconi- 
tine, 241. 
SPRAINS. 

Arnica, 247. 

Cold compress, 42. 

Icthyol, 537. 

Lead water and Opium, 
with rest, 200. 

Soap liniment, 126. 
STIFF NECK (see Torticollis). 
STOMATITIS. 

Hydrochloric acid, as caustic, 180. 

Potassium chlorate, 470. 

Thymol, 506. 
STRANGURY. 

Alkaline mineral waters freely taken 
to dilute the urine, 478-9. 

Bath, hot hip, 40. 

Camphor, 125. 

Diet ; milk and farinaceous foods. 

Liquor potassae to keep urine neutral, 

474- 
Opium and Belladonna suppository, %%. 

STRICTURE, URETHRAL. 

Belladonna, 99. 

Cocaine bougies, 134. 

Electrolysis, 51. 

Naphthaline to prevent urinary de- 
composition, 518. 
SUNSTROKE. 

Antipyrine, 527. 

Bath, cold, or wet sheet, 42. 

Morphia hypodermically, 87. 
SUPPURATION. 

Alcohol to support system, 217. 

Carbolic acid, 501. 

Lime phosphate precipitated, 465. 

Sodium phosphate, 345. 

Sulphides, 492. 
SWEATING. 

Atropia, 99. 

Camphoric acid, 125. 

Mineral acids, 177. 

Picrotoxin, 269. 

Tannin, 187. 

Vinegar and water, sponging skin 
with, 258. 



SYCOSIS. 

Carbolic acid, 501. 

Diachylon ointment, 201. 

Flaxseed poultice, 559. J- Topically. 

Sulphur ointment, 337. 

Zinc oxide ointment, 205. 
SYNCOPE. 

Alcohol, 217. 

Ammonia water, 221 ; carbonate, 
222. 

Amyl nitrite, 312. 

Cold affusions, 42. 

Digitalis, hypodermically, 281. 

Ether, 112; Etherization, 114. 
SYNOVITIS. 

Aspiration if there be suppuration, 
39- 

Blisters, 545-548. . 

Carbolic injection, 500. 

Cold applications in early stage, 42. 

Iodine tincture to promote absorption, 

447- 

Lead water and laudanum to allay 
pain, 200. 

Opium poultice, hot, to joint, 560. 
SYPHILIS. 

Auri et sodii chloridum, 444. 
. Baths, natural hot, 41. 

Blue mass, 431. 

Calomel, 436 ; by Fumigation, 437. 

Cod-liver oil, 454. 

Corrosive sublimate, internally and 
hypodermically, 439-40. 

Donovan's solution, 464. 

Gray powder, 433. 

Iodine, 446. 

Mercuric iodide, 441. 

Mercuric cyanide, 442. 

Mercurial ointment, by inunction, 432. 

Mercuric oleate, by inunction, 434. 

Potassium iodide, 450-51. 

Sarsaparilla, 381. 

Sulphur waters, 338-9-40. 
TABES DORSALIS (see Locomotor 

ataxia). 
TiENIA (see Worms). 
TETANUS. 

Amyl nitrite, 312. 

Calabar bean, 291. 

Chloral, 295. 

Etherization, 414. 

Ice-bag to spine, 42. 

Morphia, hypodermically, 85. 

Potassium, bromide, 299. 
THREAD WORMS (see Worms). 
TIC DOULOUREUX (see Neural- 
gia)- 
TINEA CAPITIS. 

Blisters, as Cantharidal collodion, 550, 
before application of parasiticide in 
severe cases. 



INDEX OF DISEASES AND REMEDIES. 



637 



TINEA CAPITIS (continued). 

Carbolic acid ointment, 501. 

Chrysarobin, 557. 

Iodine ointment or tincture, 448. 

Liquor ealcis, 483. 

Oleum hydrargyri, 434. 

Picrotoxin, 269. 

Phytolacca, 248. 

Sulphur iodide, 452. 
TINEA CIRCINATA. 

Ammoniated mercury, 442. 

Carbolic acid, 501. 

Chrysarobin, 537, preceded by Sapo 
viridis, 556, and retained by Liquor 
gutta perchae, 580. 

Corrosive sublimate in compound tinc- 
ture of benzoin, 440. 

Napthol, 520. 

Sulphurous acid, 491. 

Tar and Iodine, 407. 
TINEA VERSICOLOR (see also T. 
circinata). 

Salicylic acid, 514. 

Sapo viridis, 556. 

Sodium hyposulphite, 491. 
TRICHINA SPIRALIS % 

Active purges, as Jalap, 362, or Scam- 
mony, 368, may cause expulsion 
from intestines before sexual ma- 
turity and migration has begun, other- 
wise medicines are of little avail. 
THROMBOSIS. 

Ammonium carbonate to dissolve clot, 
222. 
TONSILLITIS, ACUTE. 

Aconite tincture, 239; or Guaiac, 382, 
to cut short. 

Alum, topically, 212. 

Iodine tincture injected into tonsils, 
448. 

Potassium chlorate gargle, 470. 

Scarifications, 36. 

Silver nitrate solution, 208. 
TOOTHACHE. 

Arsenic and Creasote, topically, 262 ; 
Creasote, 503 ; Carbolic acid, 501. 

Cocaine, 134-5. 

Laudanum, 89. 

Nervol, 542. 
TORTICOLLIS. 

Atropia, 99, or Morphia, 87, hypoder- 
mically. 

Exalgine, 508. 

Galvanism of cervical muscles, 46. 

Sinapism to neck, 541. 
TRACHOMA. 

Iodol, 534. 

Alum, 212. 

Copper sulphate, 203. 

Silver nitrate, 208. 
TUBERCULOSIS (see Phthisis). 



To 
granulations. 



TYMPANITES. 

Asafetida enema, 122. 

Turpentine oil enema, 405. 
TYPHLITIS. 

Diet ; beef-tea and milk. 

Enemata of oil and warm water to dis- 
lodge fecal accumulations, 375. 

Poultices over right iliac region, 559. 

Morphia or Opium to check peristalsis 
and relieve pain, 87. 
TYPHOID FEVER. 

Acetanilide, 506. 

Alcohol, 217, or Wine, 218. 

Antipyrine, 527. 

Bath, cold, or wet pack, 42. 

Camphor as stimulant, 125. 

Carbolic acid, 500. 

Castor-oil, 335. 

Chinoline, 522. 

Diet of first importance; milk, beef-tea 
or beef-essence. 

Digitalis, 281. 
^Iodine, 446. 

Mineral acids, 177-8. 

Naphthaline, 518; Naphthol, 520. 

Quinine, 155. 

Salol, 517. 

Thalline, 525. 
TYPHUS FEVER (see also Typhoid 
fever). 

Alcohol, 217. 

Baths, cold, if temperature be high, 42. 

Ether, 112. 
ULCER. 

Aristol, 533. 

Benzoic acid, 509. 

Bismuth, subnitrate of, 210. 

Boric acid, 493. 

Carbolic acid, 501. 

Charcoal, 538; poultice of, 559. 

Collodion, 580. 

Copper sulphate, 203, 556. 

Corrosive sublimate solution, 440-90. 

Dermatol, 537. 

Iodoform, 530-1. 

Lunar caustic, 552. 

Naphthaline, 519. 

Naphthol, 520. 

Peppermint oil, 232. 

Rectal astringent enemata, 376. 
ULCER OF CORNEA. 

Atropine or Homatropine, 100. 

Iodol, 534. 

Mercuric oxide ointment, 434. 
ULCER, GASTRIC. 

Arsenic, 461. 

Bismuth subnitrate, 209. 

Fowler's solution, 463. 

Iodol, 534. 

Nutrient enemata, 376. 

Silver nitrate, 207. 



638 



INDEX OF DISEASES AND REMEDIES. 



Topically. 



ULCER, IRRITABLE. 

Cocaine, 134. ] 

Iodoform, 530-1. 

Hyoscyamus, 104. 

Stramonium, 102. 
ULCER, RODENT. 

Caustic potassa, 553. 

London or Vienna paste, 553. 

Nitric acid, 179. 
UREMIA. 

Amyl nitrite, 312. 

Chloral, to quiet nervous symptoms, 
295. 

Cups, dry or wet, to loins, 36. 

Diuretics, as Juniper and Potassium 
bitartrate, 397 ; or Scoparius, 397. 

Hydragogues, as Elaterium, 37 1 ; Jalap, 
362 ; Scammony, 368. 

Opium or Morphia, 87 ; or Potassium 
bromide, 299, to relieve convulsions. 
URETHRITIS. 

Potassium permanganate injection, 

437- 
Zinc sulphate, 204, or acetate, injec- 
tion, 205. 
URIC ACID DIATHESIS. 

Alkaline waters, as Ballston Spa, 481 ; 
Capon Springs, 478; Clysmic, 561 ; 
Carlsbad, 351 ; Contrexville, 484; 
Marienbad, 351; Poland and Bed- 
ford, 479 ; Saratoga, 482 ; Vichy, 
479; Wiesbaden, 451 ; and Wil- 
dungen, 484. 

Liquor potassae, 474. 

Lithium benzoate, 481. 

Potassium acetate, 386; carbonate, 475; 
bicarbonate, 475. 

Rochelle salt, 347. 
URINE, AMMONIACAL. 

Benzoic acid and Ammonium benzoate, 

5°9- 
Naphthaline, 518. 
Saccharin, 583. 
URINE, INCONTINENCE OF. 

Ammonium benzoate when ammonia- 

cal, 509. 
Belladonna, 99. 
Buchu, 414. 
Catheter. 
Electricity, 48. 
Nux vomica, 264. 
URINE, RETENTION OF. 

Bath, hot, with opium in full doses, 40. 
Catheterization the best remedy. 
Naphthaline, 518. 
URTICARIA. 

Carbolic acid in glycerin, 501. 
Hydrocyanic acid dilute, topically, 309. 
Laxative mineral waters, Friedricks- 

hall and Hunyadi Janos, 351. 
Vinegar and water, sponging with, 258. 



UTERINE FIBROMA. 

Ammonium chloride, 468. 

Bromine, 555. 

Electricity, 50. 

Ergot, 273. 
VAGINISMUS. 

Cocaine topically, 134. 
VAGINITIS. 

Hops infusion, 1 10, and Grindelia by 
injection, 320. 
VARIOLA (see Small-pox). 
VERRUCA (see Warts). 
VERTIGO. 

Fowler's solution, 463, or Alkalies, 
473-8, if stomachal. 

Hydrobromic acid dilute, 301. 

Potassium bromide, 298. 

Quinine, if aural, 156. 
VIRUS OF RABID OR VENO- 
MOUS ANIMALS. 

Alcohol, 217. 

Ammonium water, 221, 551. 

Caustic potassa, 552. 

Ligature between heart and wound 
which should be sucked to with- 
draw virus. 

Potassium permanganate injected, 482. 

Silver nitrate, as cauterant, 208. 
VOMITING. 

Alkalies, 472. 

Apollinaris, 561. 

Calendula, 384. 

Calomel, 437. 

Carbolic acid, 500. 

Carbonic acid water, 561 ; Clysmic, 

384. 

Creasote, 503. 

Hydrocyanic acid dilute, 309. 
VOMITING OF PREGNANCY. 

Aconite, 240. 

Calumba, 142. 

Cerium oxalate, 21 1. 

Ingluvin, 163. 

Iodine tincture, 446. 

Ipecac, 325. 

Nux vomica, 265. 
WARTS. 

Acetic acid, glacial, 258. 

Chromic acid, 554. 

Lunar caustic, 552. 

Nitric acid, 179, 555-6. 

Potassium bichromate, 471. 

Savine, 421. 
WHOOPING COUGH. 

Asafetida, 123. 

Atropine, 99. 

Ammonium bromide, 300. 

Carbolic spray, 500. 

'Castanea, 1 96. 

Chloral, 295. 

Eucalyptus, 145. 



INDEX OF DISEASES AND REMEDIES. 



WHOOPING COUGH (continued). 

( rrindelia, 325. 

Ipecac, 324. 

Potassium bromide, 298 
WORMS, ROUND (Ascaris Lumbri- 
coides). 

Azedarach, 590. 

Calomel, 430, 592. 

Carbolic acid, 500. 

Chenopodium, 598. 

Diet, restricted. 

Iodoform, 530. 

Salicylic acid, 514. 

Santonica, 588 ; Santoninum, 589 ; 
Sodium santoninas, 5S9. 

Spigelia, 586. 

Turpentine oil, 405. 

Worm-tea, 589. 
WORMS, THREAD (Oxyuris Ver- 
micularis). 

Aloe, 356. 

Anthelmintic enemata, 375. 

Calomel, 436. 

Carbolic acid enemata, cautiously em- 
ployed, 500. 

Cod-liver oil clyster, 455. 

Frangula, 360. 

Green vegetables cooked or uncooked 
to be avoided. 

Naphthaline, 518. 

Quassia infusion enemata of, 141. 

Turpentine oil in cathartic doses, 405. 
WORMS, TAPE (Tsenia Solium). 

Aspidium, 521. 

Brayera, 592. 

Carbolic acid, 500. 

Gamboge, 370. 

Granatum, 591. 

Iodoform, 530. 

Kamala, 593. 



WORMS, TAPE (continued). 
Naphthaline, 5 1 S. 
Papaya, 164. 

Pelletierine, 591. 
Pepo, 593. 
Salicylic acid, 514. 
Turpentine oil 405, 592. 
WOUNDS. 

Adhesive or Rubber plaster, 407. 
Arnica, topically, 247. 
Benzoic acid as dressing, 509. 
Boric acid as dressing, 493-4. 
Charcoal or Yeast poultice, 559-60. 
Corrosive sublimate, 490. 
Iodoform, 531. 
Lister's method with Carbolic acid, 

5 OI « 

. Naphthaline, 519. 

Salol, 517. 

Silver nitrate, 208. 

Soap liniment, 126. 
WRITER'S CRAMP. 

Galvanism, 47. 

Massage, 52. 

Rest. 
YELLOW FEVER. 

Calomel, 436. 

Castor-oil purge, 335. 

Cracked ice to check vomiting, 43. 

Diet: milk and beef-tea. 

Hot mustard foot-bath, 541. 

Iced champagne for gastric irritabilitv, 
218. 

Ipecacuanha, 325, at onset followed by 
full dose of Quinine, 156. 

Lead acetate to check transudation 
through intestinal wall, 199. 

Sternberg's alkaline — corrosive subli- 
mate treatment, 478. 



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" J find it an excellent -work, doing credit to the learning and discrimination of the author. 




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MEDICAL AND SCIENTIFIC PUBLICA TIONS. 21 

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THERAPEUTICS. 

Napheys' Modern Therapeutics. New Revised Edi- 
tion, Enlarged and Improved. In Two Hand- 
some Volumes. 1892. 

A COMPENDIUM OF RECENT FORMULA AND THERAPEUTICAL DIRECTIONS FROM THE 

practice of eminent contemporary physicians, American and Foreign. Edited 
by Allen J. Smith, m.d., Assistant Demonstrator of Morbid Anatomy and Patholo- 
gical Histology, Lecturer on Urinology, University of Pennsylvania ; Physician in 
the Dispensary for Diseases of Children, University Hospital, etc.; and J. Aubrey 
Davis, m.d., Assistant Demonstrator of Obstetrics, University of Pennsylvania; 
Assistant Physician Home for Crippled Children, Philadelphia, etc. 
Volume I. — Medical Therapeutics. Therapeutics of Diseases of Children. 
Octavo. 1000 pages. Handsome half Russia binding, net, $6.00 

Volume II. — Surgical Therapeutics. Therapeutics of Gynecology and Ob- 
stetrics. To be ready in Autumn of iSp2. 

ANNOUNCEMENT. 

The frequent demands for a new and thoroughly revised edition of 
this popular work have induced the present publishers to have one pre- 
pared in the most complete manner, representing the latest achievements 
of therapeutical science as set forth by the most distinguished teachers 
and practitioners. The same general plan and strictly practical aims have 
been observed as in former editions. The precise formulae, specific direc- 
tions, and methods of treatment recommended by the most eminent 
American and foreign practitioners are given ; and the full resources of 
the materia medica are grouped under the various diseases to which 
they are applicable. Particular attention has been paid to describing 
the modes of employment and relative value of new remedies, including 
the latest additions to therapeutical agents. 

By a careful arrangement, all the diseases which the physician is 
likely to meet are presented systematically and discussed separately, 
including those of women and children as well as strictly medical and 
surgical complaints. It has been the aim of the editors to set forth the 
treatment of able specialists in all these departments, so that the general 
practitioner may have at his command the therapeutic resources of those 
who devote their whole attention to limited fields of disease. 

With this end in view, numerous monographs, journals, and special 
papers, both in this country and Europe, have been consulted and their 
most useful therapeutic suggestions extracted. No other work on the 
subject will be found so thoroughly and constantly useful to the practic- 
ing physician, because no other supplies so directly and with such ease 
of reference the information he desires. 

The whole work has been rearranged, the better part rewritten, 
and every page will show improvements or additions. A large number 
of new and representative prescriptions have been added to the text. 

It has been thought desirable to include Diseases of Women and 
Children in the two volumes instead of publishing separately, as before. 



THERAPEUTICS AND MATERIA MEDICA. 

Potter's Materia Medica, Pharmacy and Therapeutics. 
Third Edition. Revised and Enlarged. 1891. 

A HANDBOOK OF MATERIA MEDICA, PHARMACY AND THERAPEUTICS including the Phy- 

siological Action of Drugs, Special Therapeutics of Diseases, Official and Extempo- 
raneous Pharmacy, etc. By Sam'l O. L. Potter, m.a., m.d., Professor of the 
Practice of Medicine in Cooper Medical College, San Francisco ; Late A. A. Sur- 
geon, U. S. Army; Author of "Speech and its Defects," and the " Quiz-Compends " 
of Anatomy and Materia Medica, etc. Revised, Enlarged and Improved. Octavo. 
With Thumb Index. Leather, $5.00 

" The author has aimed to embrace in a single volume the essentials of practical materia medica and 
therapeutics, and has produced a book small enough for easy carriage and easy reference, large enough to 
contain a carefully digested, but full, clear and well-arranged mass of information. He has not adhered to 
any pharmacopoeia, as is the case of certain recent manuals, thereby limiting his work, and in this day of new 
remedies causing constant disappointment, but has brought it up to date in the most satisfactory way. No 
new remedy of any acknowledged value is omitted from this list. Under each the section on physiological 
action and therapeutics has been written with care. ... In the enumeration of drugs suited to different 
disorders a very successful effort at discrimination has been made, both in the stage of disease and in the cases 
peculiarly suited to the remedy. It is no mere list of diseases followed by a catalogue of drugs, but is a digest 
of modern therapeutics, and as such will prove of immense use to its possessor." — The Therapeutic Gazette. 

A Unique Book. — The plan of this work is new and original with Dr. Potter, and its 
contents have been combined and arranged in such a way that it offers a compact statement 
of the subjects in hand, containing more correct information in a practical, concise form 
than any other publication of the kind. 

The work commences with a section on the classification of medicines, as follows : — 

Agents acting on the Nervous System, Organs of Sense, Respiration, Circulation, 
Digestive System, on Metabolism (including Restoratives, Alteratives, Astringents, Anti- 
pyretics, Antiphlogistics and Antiperiodics, etc.) Agents acting upon Excretion, the 
Generative System, the Cutaneous Surfaces, Microbes and Ferments, and upon each other. 

Part I. — Materia Medica and Therapeutics (351 pages), the drugs being 
arranged in alphabetical order, with the synonym of each first ; then the description of 
the plant, its preparations, physiological action, and lastly its Therapeutics. 

Part II. — Pharmacy and Prescription Writing (56 pages). This is written for 
the use of physicians who desire or of necessity must put up their own prescriptions, and 
includes — Weights and Measures, English and the Metric Systems ; Specific Gravity and 
Volume; Prescriptions, their principles and combinations; proper methods of writing 
them ; Abbreviations ; Stock solutions and preparations, and Incompatibility, etc. 

Part III. — Special Therapeutics (211 pages) is an alphabetical List of Diseases — 
a real Index of Diseases — giving the drugs that have been found serviceable in each 
disease, and the authority recommending the use of each, a very important 
feature, as it gives an authoritative character to the book that is unusual in works on 
Therapeutics, and displays an immense amount of research on the part of the author. 
600 Prescriptions are given in this part, many being over the names of eminent men. 

The Appendix (36 pages) contains lists of Latin words, phrases and abbreviations, 
with their English equivalents, Genitive Case Endings, etc. 36 formulae for Hypodermic 
Injections; 10 of Chlorodyne; Formulae of prominent patent medicines; Poisons and 
their Antidotes; Differential Diagnosis; Temperature Notes; Obstetrical Memoranda; 
Clinical Examination of Urine; Table of Specific Gravities and Volumes; Table showing 
the number of drops in a fluidrachm of various liquids, the weight of one fluidrachm in 
grains, and a table for converting apothecaries' weights and measures into grams, etc., etc. 

The Index covers thirty-five pages, and will be found very elaborate. 

The whole work is a statement of known facts in terse language; it is, in fact, the 
essentials of Practical Materia Medica and Therapeutics. Although it is to a great extent a 
compilation, as any such book must be, from the works of prominent writers and teachers, 
yet it will be found to contain much original matter and many useful suggestions not 
included in any other book. 



PRACTICE OF MEDICINE. 

Roberts' Practice of Medicine. Eighth Edition. Re- 
vised, Enlarged and Illustrated. 

A HANDBOOK OF THE THEORY AND PRACTICE OF MEDICINE. By FREDERICK T. 

Roberts, m.d., b.Sc, f.r.c.p., Professor of Materia Medica and Therapeutics, and 
of Clinical Medicine, at University College Hospital, London; Physician to Bromp- 
ton Hospital for Consumption and Diseases of the Chest, etc. Eighth Edition. 
Revised and Enlarged. 51 Illustrations. 1059 pages. Octavo. 

Handsome Cloth, $5.50; Full Sheep, Raised Bands, $6.50 

" The various subjects have been treated in a complete and masterly manner. . . . We heartily 
commend this handbook, not only to gentlemen preparing for the medical profession, but to those who may 
have finished their professional education; as this work contains, in a brief and concise shape, all that the 
busy general practitioner needs to know to enable him to carry on his practice with comfort to himself and 
with advantage to his patients." — British Medical Journal. 

" It is unsurpassed by any work that has fallen into our hands as a compendium for students." — The Clinic. 

"We particularly recommend it to students about to enter upon the practice of their profession." — St. 
Louis Medical and Surgical Journal. 

"If there is a book in the whole of medical literature in which so much is said in so few words, it has 
never come within our reach." — Chicago Medical Journal. 

" The regularity with which fresh editions of this admirable text-book make their appearance, serves to 
show that it continues to maintain its favored position with the student, who finds it a safe and reliable guide. 
Apart from the clearness of style and its thoroughly practical character, a great feature of Dr. Roberts' work 
is the systematic method with which each subject is treated. The value of this kind of instruction is high, as 
it enables the student to marshal his ideas in an orderly manner, and to assign to each part its special 
importance. The author has not been unmindful of the necessity of keeping his book ' up to date,' and he 
has evidently bestowed much pains on its revision. It is enough to say that it fully merits its popularity." — 
The Lancet, London, February 7th, 189 1. 

" The arrangement of the subject is admirable, each disease is very fully considered in elegant phraseology 
without any undue verbosity, and the matter is presented in a manner which is easily grasped and retained in 
the memory. It is quite unnecessary to refer further to the pages of this valuable and reliable text-book. It 
will be found a trustworthy guide both by students and practitioners, and the latter will find much more infor- 
mation as to treatment, than is usually recorded in such works." — Liverpool Medico- Chir. Journal, Jan., 1891. 

Hughes' Compend of the Practice of Medicine. 4th 
Enlarged Edition. 

A COMPEND OF THE PRACTICE OF MEDICINE. By DANIEL E. HUGHES, M.D., late 

Demonstrator of Clinical Medicine at Jefferson Medical College, Philadelphia; now 
Physician-in-Chief, Philadelphia Hospital In two parts. 

Part I. — Continued, Eruptive and Periodical Fevers, Diseases of the Stomach, Intes- 
tines, Peritoneum, Biliary Passages, Liver, Kidneys, etc., and General Diseases, etc. 

Part II. — Diseases of the Respiratory System, Circulatory System and Nervous 
System; Diseases of the Blood, etc. Price of each Part, strongly bound in cloth, $1.00 

Interleaved for the addition of notes, 1.25 

*^* These books are a complete set of notes upon the practice of medicine. The 
synonyms, definition, causes, symptoms, pathology, prognosis, diagnosis, treatment, etc., 
of each disease being given. The treatment is especially full and a number of valuable 
prescriptions have been incorporated. Reference has been made to the latest writings 
and teachings of Drs. Flint, Roberts, Loomis, Bartholow, DaCosta, etc. Dr. Hughes' 
long experience as demonstrator of clinical medicine under the last named famous pro- 
fessors gave him unrivaled opportunities for the preparation of a book of this character. 

Physicians' Edition. Fourth Edition. Same as above, but in one volume, 
and including a section on Skin Diseases and a very complete index. 

Full Morocco, Gilt Edges, $2.50 
" The best condensation of the essentials of Practice I have yet seen. ... It will be an admirable 
review book for students after a solid course of study, and it will be scarcely less useful to the busy practi- 
tioner as a ready means of refreshing his memory." — C. A. Lindsley, M.D., Professor of Theory and Prac- 
tice of Medicine, Yale College, New Haven. 



NEW AND REVISED EDITIONS. 

PQUIZ-COMPENDS.? 

A SERIES OF PRACTICAL MANUALS FOR THE PHYSICIAN AND STUDENT. 

Compiled in accordance with the latest teachings of prominent lecturers 
and the most popular Text-books. 

Bound in Cloth, each $1.00. Interleaved, for the Addition of Notes, $1.25. 

They form a most complete, practical and exhaustive set of manuals, containing information nowhere else 
collected in such a practical shape. Thoroughly up to the limes in every respect, containing many new pre- 
scriptions and formulae, and over 300 illustrations, many of which have been drawn and engraved specially for 
this series. The authors have had large experience as quiz-masters and attaches of colleges, with exceptional 
opportunities for noting the most recent advances and methods. The arrangement of the subjects, illustrations, 
types, etc., are all of the most approved form. They are constantly being revised, so as to include the latest 
and best teachings, and can be used by students of any college of medicine, dentistry and pharmacy. 

No. 1. Human Anatomy. Fifth Edition (1891), including Visceral Anatomy, formerly pub- 
lished separately. 16 Lithograph Plates, Tables, and 117 Illustrations. By Samuel O. L. 
Potter, m.a., m.d., late A. A. Surgeon, U. S. Army. Professor of Practice, Cooper Med. College, 
San Francisco. 

Nos. 2 and 3. Practice of Medicine. Fourth Edition, Enlarged (1890). By Daniel E. Hughes, 
M.d., late Demonstrator of Clinical Medicine in Jefferson Med. College, Phila. ; Physician-in Chief, Phila- 
delphia Hospital. In two parts. 

Part I. — Continued, Eruptive and Periodical Fevers, Diseases of the Stomach, Intestines, Peritoneum, Biliary Passages, 
Liver, Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Physical Diagnosis), Circulatory System and Nervous System; 
Diseases of the Blood, etc. 

*** These little books can be regarded as a full set of notes upon the Practice of Medicine, containing the Synonyms, 
Definitions, Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each disease, and including a number of prescrip- 
tions hitherto unpublished. 

No. 4. Physiology, including Embryology. Sixth Edition (1891). By Albert P. Brubaker, m.d., 
Prof, of Physiology, Penn'a College of Dental Surgery; Demonstrator of Physiology in Jefferson Med. 
College, Phila. Revised, Enlarged and Illustrated. In Press. 

No. 5. Obstetrics. Illustrated. Fourth Edition (1889). For Physicians and Students. By Henry 
G. Landis, m.d., Prof, of Obstetrics and Diseases of Women, in Starling Medical College, Columbus. 
Revised Edition. New Illustrations. 

No. 6. Materia Medica, Therapeutics and Prescription Writing. Fifth Revised Edition (1891). 
With especial Reference to the Physiological Action of Drugs, and a complete article on Prescription 
Writing. Based on the Last Revision (Sixth) of the U. S. Pharmacopoeia, and including many unofficinal 
remedies. By Samuel O. L. Potter, m.a., m.d., late A. A. Surg. U. S. Army; Prof, of Practice, 
Cooper Med. College, San Francisco. 5th Edition. Improved and Enlarged. 

No. 7. Gynaecology. (189 1.) A Compend of Diseases of Women. By Henry Morris, m.d., Demon- 
strator of Obstetrics, Jefferson Medical College, Philadelphia. Many Illustrations. 

No. 8. Diseases of the Eye and Refraction. Second Edition (1888). Including Treatment and 
Surgery. By L. Webster Fox, m.d., Chief Clinical Assistant Opthalmological Dept., Jefferson Medical 
College, etc., and Geo. M. Gould, m d. 71 Illustrations, 39 Formulae. 

No. 9. Surgery, Minor Surgery and Bandaging. Illustrated. Fourth Edition (1890). Including 
Fractures, Wounds, Dislocations, Sprains, Amputations and other operations ; Inflammation, Suppuration, 
Ulcers, Syphilis, Tumors, Shock, etc. Diseases of the Spine, Ear, Bladder, Testicles, Anus, and other 
Surgical Diseases. By Orville Horwitz, a.m., m.d., Demonstrator of Surgery, Jefferson Medical 
College. 84 Formulae and 136 Illustrations. 

No. 10. Medical Chemistry. Third Edition (1890). Inorganic and Organic, including Urine Analysis. 
For Medical and Dental Students. By Henry Leffmann, m.d., Prof, of Chemistry in Penn'a College 
of Dental Surgery, Phila. Third Edition. Revised and Enlarged. 

No. 11. Pharmacy. Third Edition (1890). Based upon " Remington's Text-Book of Pharmacy." By 
F. E. Stewart, m.d., ph.g., Professor of Pharmacy, Powers College of Pharmacy; late Quiz-Master at 
Philadelphia College of Pharmacy. Third Edition. Revised. 

No. 12. Veterinary Anatomy and Physiology. Illustrated. (1890.) By Wm. R. Ballou, m.d., Prof, 
of Equine Anatomy, New York College of Veterinary Surgeons, etc. 29 Illustrations. 

No. 13. Dental Pathology and Dental Medicine. (1890.) Containing all the most noteworthy points 
of interest to the Dental Student. By Geo. W. Warren, d.d.s., Clinical Chief, Penn'a College of 
Dental Surgery, Philadelphia. Illus. 

No. 14. Diseases of Children. (1890.) By Marcus P. Hatfield, Professor of Diseases of Children, 
Chicago Medical College. With Colored Plate. 

These books are constantly revised to keep up with the latest teachings and discoveries. 



From The Southern Clinic. — " We know of no series of books issued by any house that so 
fully meets our approval as these ? Quiz- Compends ? They are well arranged, full and concise, 
and are really the best line of text-books that could be found for either student or practitioner :" 



Potter. A Compend of Anatomy. Fifth Edition. 
1 6 Lithograph Plates. 117 other Illus. 

including the viscera. {Based on Gray.) By Saml. O. L. Potter, m.a,, m.d., 
late A. A. Surg. U. S. Army ; Professor of the Practice of Medicine, Cooper Medical 
College, San Francisco. Revised and Enlarged. i2mo. Being No. i ? Quiz- 
Compend? Series. Seepage 29. Strongly bound in cloth, $1.00 

Interleaved, for the addition of notes, 1.25 

\* An Appendix has been added to this edition, containing 16 Lithographic Plates of the Arterial and 
Nervous Systems, with explanatory tables that will be found exceedingly useful and practical. We 'would 
call special attention to these tables, as being entirely original in design and arrangement, giving graphic 
views of the most difficult part of Human Anatomy, and including anastomoses (the arteries) and distri- 
bution (the arteries and nerves) ; a thing never before shown completely in tabular form. The different types 
are so arranged as to grade the branches according to relative importance, and by the systematic and ingenious 
use of brackets with various types, the tables are veritable pictures themselves of their objects. 

Dr. Potter's power of condensation and arrangement, have never been displayed to such advantage as in 
these tables, which must take their proper place as the best of all attempts of the kind, even in the restricted 
space of pages the size of which was previously determined, and to which the tables had to conform. 

The plates are equally original, having been made from new drawings by Dr. Potter's own hand ; they 
are graphic delineations, and being diagrammatic, do not represent the exact forms or proportions of the parts 
thus shown. If colored by hand, by the student, as may be done with very little trouble, their value will be 
greatly increased. 

" In the particular line to which it belongs, and as one of the pioneers, this work of the indefatigable Dr 
Potter stands in the list of the very best. This is particularly conspicuous in view of the many failures to 
render the subject of anatomy attractive when presented in compends." — American Practitioner and News, 
January, 189 1. 

"This is ? Quiz- Compend No. 1, based on Gray principally, and is a book that to a student is almost a 
necessity, and to the practicing physician a great aid as a ready reference work, enabling him, at almost a 
glance, to keep in mind a great many valuable points in anatomy that otherwise he would forget." — The Cin- 
cinnati Medical Journal, February 15th, i8qi. 

" Of all the studies in a medical course, anatomy is the most important. To wade through a ' Gray,' for 
review, is very irksome, and by having an Anatomy in an epitomized form and thoroughly reliable, both time 
and labor will be saved. Dr. Potter has thus conferred a boon on both the student and practitioner alike, by 
publishing his Compend of Anatomy. The tables and plates of the nerves and arteries are excellent ; these 
constitute the Appendix, and by their aid one can review this important part of the work in a short space of 
time." — Canada Lancet, Toronto, February, i8qi. 

Robinson. The Latin Grammar of Pharmacy and 
Medicine. 

By H. D. Robinson, ph.d., Professor of Latin Language and Literature, University 
of Kansas, Lawrence. With an Introduction by L. E. Sayre, ph.g., Professor of 
Pharmacy, and Dean of the Dept. of Pharmacy, in the University of Kansas. i2mo. 
2 75 Pages. Cloth, $2.00 

" It is a work that meets with my hearty approval. There is great need of just such a book in our 
American schools of pharmacy and medicine." — E. S. Bastin, Professor of Botany, Dept. of Pharmacy, 
Northwestern University , Chicago. 

" The object of this useful book is a very laudable one, namely, to improve, if possible, the Latin used by 
both physicians and druggists, chiefly in the prescribing of drugs. While it is true that many of the profession 
find it unnecessaiy to remember the genitive endings of words used in medicine, because of the customary 
abbreviations in prescribing-writing, there are others who frequently desire to write their directions to the 
druggist in Latin, in order that the patient may not learn of facts about which it is often necessary for him to 
remain in ignorance. We hope that the book will prove a success, and by its general employment in both 
pharmaceutical and medical schools, improve the knowledge of Latin in both professions." — The Medical 
News, Philadelphia, January 10th, 1 891. 

" The plan of the book is excellent, the field new, as it fills a long-felt want. All medical students 
should have it, both the collegian, as it will give a practical turn to his knowledge of Latin, and the non- 
graduate, as it will give him a direct and useful acquaintance with that language. The country doctor who 
has not had the advantages of the younger men will find it a great help in overcoming this defect, and may 
speedily acquire a familiarity with this language that will surprise his classical confrere.'" — Southern Cal. 
Practitioner, December, 1890. 




NURSING, MASSAGE, ETG. 

Ostrom. Massage and the Original Swedish Move- 
ments. Illustrated. Second Edition. 

AND THEIR APPLICATION TO VARIOUS 

diseases of the body. A Manual for 
Students, Nurses, and Physicians. By 
Kurre W. Ostrom, from the Royal 
University of Upsala, Sweden ; In- 
structor in Massage and Swedish Move- 
ments in the Hospital of the University 
of Pennsylvania and in the Philadel- 
phia Polyclinic and College for Gradu- 
ates in Medicine, etc. Illustrated by 87 
explanatory Wood Engravings, drawn 
specially for this purpose. i2mo. Sec- 
ond Edition. Cloth, $1.00 

" This book, which is well written and carefully illustrated, will be of service both to physicians and 
nurses as well as to manipulators. Mr. Ostrom, who came to this country from Sweden, has proven himself 
a capable teacher as well as a good masseur, his instructions being careful, accurate, and complete." — 
University Medical Magazine, Philadelphia, March, i8qo. 

Parvin. Obstetric Nursing. 

LECTURES DELIVERED AT THE TRAINING SCHOOL FOR NURSES OF THE PHILADELPHIA 

hospital. By Theophilus Parvin, m.d., Professor of Obstetrics and Diseases of 
Women and Children in the Jefferson Medical College ; Obstetrician to the Phila- 
delphia Hospital. Revised and Enlarged. i2mo. Cloth, $ .75 

Humphrey. A Manual for Nurses. 4th Edition, 

including general anatomy and physiology, Management of the Sick-Room, etc. 

By Laurence Humphrey, m.d., m.r.c.s., Ass't Physician to, and Lecturer at, Adden- 

brook's Hospital, Cambridge, England. i2mo. 79 Illustrations. Cloth, $1.25 

" That a work of such a character should be addressed to nurses at all is in itself a significant indication 
of the high standard to which the art of nursing has risen in recent years, and also a good proof of the 
estimation in which really good nursing is held alike by the public and by medical men. To the intelligent 
and often well educated women who now take up nursing either as an occupation or as a profession, some 
theoretical training in the elements of anatomy and physiology is very generally recognized as necessary by 
all hospital authorities. , . ." — The Practitioner, London, April, 18 go. 

Fullerton. Obstetrical Nursing. Illustrated. 

A HANDBOOK FOR NURSES, STUDENTS, AND MOTHERS. By ANNA M. FULLERTON, M.D., 

Demonstrator of Obstetrics in the Women's Medical College; Physician in charge 
of, and Obstetrician and Gynaecologist to, the Woman's Hospital, Philadelphia, etc. 
34 Illustrations, several of which are original. Second Edition, Revised and Enlarged. 
i2mo. 222 pages. Cloth, $1.25 

BY THE SAME AUTHOR. 

Nursing in Abdominal Surgery and Diseases of 
Women. 

COMPRISING THE REGULAR COURSE OF INSTRUCTION AT THE TRAINING SCHOOL OF THE 

woman's hospital, Philadelphia. 70 Illustrations. i2mo. 284 pages. Cloth, $1.50 



OBSTETRICS— GYNECOLOGY. 

Winckel's Text-Book of Obstetrics. With many 
Original Illustrations. 

INCLUDING THE PATHOLOGY AND THERAPEUTICS OF THE PUERPERAL STATE. By 

Dr. F. Winckel, Professor of Gynaecology and Director of the Royal Hospital for 
Women in Munich. Authorized Translation, by J. Clifton Edgar, m.d., Adjunct 
Prof, of Obstetrics, Medical Depart., University of the City of New York. - 192 hand- 
some illustrations, the majority of which are original with this work. 927 pages. 8vo. 

Cloth, $6.00; Sheep, $7.00 

" His practical experience and laborious researches in the literature of the subject have qualified him to 
place before the profession a book which is certainly of great value, and we desire to compliment Dr. Edgar 
upon his foresight and admirable work in the preparation of the American translation. One of the useful 
things about the work is that bibliographies accompany the articles upon each special subject, while the illus- 
trations seem to us to be almost entirely original, which is but natural when we consider the enormous amount 
of material from which the author may obtain figures. The work of the American publisher has been well 
carried out, as it is usual under the circumstances, and we venture to say the translation is put before the pro- 
fession of this country in much better form than the German publishers placed the original before the physi- 
cians of the Fatherland." — Medical News, Philadelphia. 

" These -additions make the perusal of the work a labor of pleasure, besides adding greatly to its value. 
One lays down the book with a heightened admiration for the author's learning, as well as a deep respect for 
his careful and conservative teaching." — American Journal of Obstetrics, New York. 

" In this hasty manner we have only sought to call attention to the salient points of this admirable work, 
which, though intended and especially adapted to the student, nevertheless will well repay a careful perusal by 
all who aspire to practice obstetrics according to the most improved modern methods. We would like to see 
this text-book used in this country, for the reason that it is clear and concise, that it gives special prominence 
to pathology, and that every page bears evidence of that thoroughness and sound conservatism which makes 
its distinguished author unequaled as a teacher of obstetrics." — Medical Record. 

Win # ckel. Diseases of Women. By Parvin. Second 
Edition, Enlarged. 

including diseases of the bladder and urethra. By Dr. F. Winckel, Professor 
of Gynaecology and Director of the Royal University Clinic for Women in Munich. 
Authorized Translation. Edited by Theophilus Parvin, m.d., Professor of Obstet- 
rics and Diseases of Women and Children in Jefferson Medical College, Philadelphia. 
Second Edition, Revised and Enlarged. 152 Engravings on Wood. i2mo. No. 2, 
New Series of Manuals. 766 pages. Cloth, $3.00; Leather, $3.50 

" The popularity of the work is shown by the rapidity with which the first edition was exhausted. There 
is, perhaps, no more scholarly or influential authority on gynaecological subjects among our German confreres 
than Winckel, and this fact, added to the respect and esteem in which his American editor is universally held, 
may serve to explain the early demand for a second edition in advance of a second German edition. . . . 
A novel feature is furnished by the chapters on diseases of the mammary gland. They are not generally dis- 
cussed in works of this character, but we have always been of the opinion that their consideration was quite 
as appropriate as that of any other portion of the genital apparatus, of which they form an essential element." 
— The American Journal of the Medical Sciences, Philadelphia. 

" It is nearly three years since we had the pleasure of reviewing the English translation of Professor 
Winckel's ' Diseases of Women.' The favorable comments we then made we have now but to endorse in 
connection with the second edition of this excellent, lucidly written gynaecological work. Dr. Theophilus 
Parvin has most thoroughly revised the former issue, so that the reader meets with only the latest and most 
matured opinions on the various debatable topics. We should like again to direct the attention of those inter- 
ested in gynaecological literature to the subjects on pelvic neoplasms and diseases of the female urethra and 
bladder. The work is profusely illustrated, and we feel confident that those of our readers who accord it 
careful study will derive much pleasure and instruction from its pages." — The Practitioner, London. 



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